Recommended Read: Toxic Staff 

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

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

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

Examples? Sure:

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

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

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

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

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

 

And on and on and on. 

Source: www.betterup.com 

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

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

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

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

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

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

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

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

Source: www.hcamag.com 

** More Info:

Preventing Burnout 

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

What is Ethical Leadership?

Developing Leadership in Your ABA Team

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

A New Model for Ethical Leadership 

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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

Read more »

Tameika Meadows, BCBA, Blog Author

 

Recommended Reading:

VB -MAPP assessment tool

ABLLS-R assessment tool

AFLS assessment tool

The Practical Functional Behavior Assessment

There are many commercial assessment tools out there that are purchased and utilized by ABA practitioners, typically at the BCBA level (BCBAs typically are the ones conducting new client intake). 

Often when I work with supervisees (meaning individuals pursuing BCBA certification) or very new practitioners, they have many questions about Assessment. Such as, which tool to select for which client, pros and cons of each tool, what materials to use (particularly if the employer does not provide assessment kits), differences between assessing a younger child vs a young adult or adult, differences in assessing in the home vs community settings, etc. And of course, varying funder requirements will also influence which assessment tool is selected and even how much time is allowed to conduct an assessment.

In summary, the questions focus on "HOW". How do I pick the best assessment, for this client, in this particular setting, to gain the most helpful information?

Because at the end of the day, that IS the point of assessment: to gain valuable and salient information about the client that will guide programming and determine which goals to prioritize for treatment. 

Putting aside the specific options for a moment, the key characteristics of a quality client assessment will include the following: 

• A variety of methods across both direct and indirect observation, interviews, checklists, tests, and/or direct skill probing to identify and define targets for intervention 
• The priorities and areas of concern of the client, client caregiver/parents, or other caregivers close to the client
• Record review of pertinent files or reports
• Selection & measurement of goals
• Problem behavior identification, measurement, and assessment

The assessment process is an absolute necessity to beginning treatment with any client. Regardless of age, setting, areas of concern, treatment model, etc., without proper assessment the intervention isn't likely to be effective or achieve true long-lasting change.

More important than the specific tool to select, is the ability to conceptualize treatment and prioritize goals. Assessment tools do have characteristics in common, and a big one is the assessor must already have an understanding and knowledge of capturing client attention, delivering the SD, prompting and prompt fading, data measurement, and conducting a thorough interview to gather important information about client functioning. For this reason, although some organizations will assign non-BCBAs to conduct assessments it is critical that the assessor (regardless of certification level) have the appropriate skillset and training to administer an assessment.

It is also important to recognize that the client's needs should guide assessment tool selection, and not just the tools that are available, the BCBA preference of tool, or other non-critical decision factors. Many organizations may only have 1 or 2 assessment tool options, which would then mean the clients served would need to be narrowed to the ones most appropriate for the assessment tools (e.g. if an organization does not have an appropriate assessment tool for early intervention, then early intervention clients should not be admitted). 

Lastly, let's not forget that completing a thorough assessment is meaningless if it isn't then connected to goal setting. What was the point of identifying barriers to learning, maladaptive behaviors, and skill deficits impeding daily functioning, if these goals never show up in the treatment plan? Or are never addressed in therapy? It is possible to overfocus on the assessment tool to the point that important, necessary daily life skills get neglected. For example: assuming that because a client has "filled" an assessment grid, they are now done with therapy/have no further need of intervention. 

If the assessment (when I use the word "assessment", I mean a combination of record review, interview, observation, and direct skill probing) identifies Gross Motor Skills, Manding, and Vocal Imitation as areas of significant concern, then programming for those areas should be reflected in the treatment plan. The absence of this, is often seen in "cookie-cutter interventions". Cookie-Cutter interventions can be recognized by their disconnect from the individual priorities or high need areas, and by their generic replication across multiple clients. While it is true that many clients with no prior intervention will present similarly (may share struggles with social skills or toileting), this is not the same thing as saying "Here are the 10 goals I select for ALL 5 -year- olds", or "Here is how I teach Toileting for ALL toddlers". If ABA is not customized and individualized, it isn't really ABA. 

 

*References - 

Cooper, Heron, & Heward (2014). Applied Behavior Analysis

http://elisabethcassinari.com/assisting-individualized-assessment-procedures/ (great resource!)

The Council of Autism Service Providers (2020) Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers

*Awesome Resource - 

"ABLLS-R, AFLS, VBMAPP, ESDM, PEAK!?!? Choosing the Right Assessment for Your Learner with Autism"

Read more »

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 

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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?

Read more »

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.

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Tameika Meadows, BCBA, Blog Author

Today's quote of the day is from ..... Me!


See below for an excerpt about knowing your identity as a clinician, from my newest book, The Practical ABA Practitioner:

*Recommended Reading:

Runnin' on Empty

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Tameika Meadows, BCBA, Blog Author

If you haven't experienced it yet as a supervisor/Program Lead/BCBA, you will: Being in charge of those who want no one in charge of them.

Sounds like a riddle or something. But in real life, it's much less humorous.

As someone in a leadership position (regardless of your actual title), you probably imagined your job would include lots of mentoring, providing support and encouragement, staying available to your team, selflessly putting their needs before your own, and definitely.. absolutely.. NOT being like that one supervisor you had who was just the worst.
You probably imagined your team or supervisees would accept your teaching and support with gladness, gratitude, and a huge "Thank you so much, you're the best!".

So it can be a pretty big let down when instead your efforts are met with disdain, condescension, irritation, or just flat out insubordination.
When no one is implementing your behavior plan.
Or no one on the team ever replies to your emails.
Or your supervisee requests to work with a different BCBA.

Again, if you haven't experienced this yet, just give it time. It's darn near impossible to move into a position of leadership and never have to deal with difficult people. Actually, I would say the higher up in leadership you climb, the more opportunity you have to deal with difficult people.

So if I may, I'd like to offer some tips for this daunting challenge. Here is what I've found helpful in the past:

First, check yourself -

1.      Are you making a difficult situation worse by being overly offended, getting all wrapped up in your feelings, and assuming the person hates you just because they don’t listen to you? Guess what? When you are the boss, everyone won’t like you. There really is no way around that. Stop taking things so personally.

2.      Have you calmly and clearly communicated your expectations, specified the areas where they aren’t being met, and helped the difficult person create an action plan? No? Why not?

3.      Do you spend more time at work complaining about the difficult person, rather than talking to the difficult person? Come on, be honest.

4.      Have you lost your objectivity? Do you get tense, sigh heavily, and roll your eyes every time this person calls you or sends you an email? If so, then your irritation is likely coming through in your interactions with this person.

After you have honestly looked at your own behavior (do not skip that part, it’s really important), now it’s time to take a good look at your supervisee/employee -

1.      Is this an issue of poor fit? Sometimes you have to taste the food to know you don’t like it. Similarly, some people need to start working for the company, or hold the position, before realizing it isn’t for them. Have an open conversation with the difficult staff about their current contentment with their role/the company.

2.      Look at the reinforcement history: has this person had good supervision/leadership experiences before? How do you compare to their previous leaders? Are they simply not used to having high expectations placed on them? It's hard to follow when you've never been led.

3.      What career goals does this person have? One of the most effective ways I have found for dealing with difficult supervisees is to help them connect their personal career goals to their current work performance. For example, if you know the staff is pursuing their BCBA then help them connect the dots between being able to accept feedback now, and how much more challenging it will be to accept feedback you don’t agree with as a BCBA. These clinical “soft skills” only become more important the higher up you go in this field, so it’s important to learn professionalism and humility now.

4.      Lastly, are you dealing with a toxic employee? If so, then move straight to GO, and collect $200. 😊 Unfortunately, a toxic employee has the potential to bring so much harm to staff morale, client satisfaction, and work culture, that it may be a better decision for the sake of the whole team to part ways, and wish them the best of luck with their next employer.

** Helpful Resources:

“Quantifying Efficacy of Workplace Reinforcers: An Application of Behavioral Economic Demand to Evaluate Hypothetical Work Performance”,  Amy Henley et al (2016)

8 Things Leaders Do that Make Employees Quit

An OBM Approach to Employee Performance

6 Ways to Engineer Bad Performance

Read more »

Tameika Meadows, BCBA, Blog Author

"Bad bosses compel good employees to leave"
www.Forbes.com

"The way your employees feel is the way your customers will feel. And if your employees don't feel valued, neither will your customers"

Sybil F. Stershic

"The only thing worse than training your employees and having them leave not training them and having them stay"

Henry Ford

"Strive not to be a Success, but rather to be of Value"

Albert Einstein

"You don't get paid for the hour. You get paid for the value to bring to that hour"
Jim Rohn

Get Excited!

For those of you out there, laboring away, giving your all to your clients, working from 8am to 8pm every day (and getting paid for 1/2 that time), typing up 20 page reports at 2 am, laminating flashcards until your fingers are sore, putting hundreds of miles on your car, going to work bruised, discouraged, and exhausted, and eating your lunch in your car...I have something for YOU.

My newest book, 'The Practical ABA Practitioner', uncovers and openly discusses all aspects of ABA practitioner life, as in the good, the bad, & definitely the ugly. ;-)
This book is all about the practitioner experience working in this field, the day-to-day reality, how to plan out a successful career, and what common pitfalls to avoid. Especially for those of you brand new to the field, or newly certified.


If you want to work in this field, you need to read this book.
If you're tired of working in this field, you need to read this book.
If you LOVE working in this field, you need to read this book.

In preparing to write this book, I talked to lots and lots of practitioners about their experiences working in this field, reached back into my own early days as an in-home ABA therapist, and I also perused the resources out there about ABA as a career: What's it like being a BCBA? What are the pros and cons to becoming an RBT? What are the joys, the pressures, and the challenging to meet expectations of this industry?


Dying for some specific details about the book? Sure!
 "The Practical ABA Practitioner" addresses:

• Professional Burnout. Yup. I dedicated an entire chapter to discussing loving what you do, but hating the way you have to do it, and being eternally exhausted. You're welcome.
• The end of the book is a huge treasure trove of practical practitioner tips and resources (handouts, job performance tips, staff satisfaction surveys, suggested parent policies, etc.) that will help you do your job better. Seriously, its just pages and pages of stuff. :-)
• Work-Life balance as a busy full-time BCBA: Fiction or Reality?
• Developing and refining your clinical identity as an ABA practitioner.
• What are employers looking for when hiring RBT's? What about BCBA's?
• Should you pursue BCBA certification? Is it really for you?
• How to revitalize your passion for this field.
• What kinds of pitfalls should newbie BCBA's watch out for (because they're vulnerable to these issues)?
• Why are the staff retention rates in this field so terrible? To put it another way, why are so many ABA companies bleeding staff?
• Tips for choosing between various employment options, and red-flags to look out for.
• How to BE the change when working in less-than-ideal conditions.
• Holding this field accountable for the way we treat direct staff/ABA implementors.
• How to to develop your personal value system in this field, and practice with integrity.
• How to be truly successful as a practitioner, for years and years to come.
• What are some of the main reasons why quality practitioners walk away from this field, and don't look back. And how we can keep them from walking away.

Treat yourself, and do something GREAT for your career... get this resource and be encouraged and strengthened.

Click here to find this brand new resource on Amazon!

Read more »

Tameika Meadows, BCBA, Blog Author

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

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Tameika Meadows, BCBA, Blog Author

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:

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. 

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Tameika Meadows, BCBA, Blog Author

Suggested Reading:

The "Why" of Selecting Intervention Goals



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

In an ideal world, this plan of action would be as comprehensive, detailed, and lengthy, as it needed to be for the individual client to benefit from treatment. But since this is rarely an ideal world, all kinds of issues and constraints can lead to having to prioritize treatment goals. Basically, this means to ask (and answer) the question: "What are the MOST important things to work on?".

While many clients may need some level of support for the rest of their lives, often therapy services have a specific timeframe or clock to work within, as well as limits on how services must be provided (what location, at what intensity, etc.) that are set by the funding source and not by the clinician.

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

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

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

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

*Further Resources:

How to Prioritize ABA Therapy Goals

3 Important Things to Consider When Starting Intervention

10 Essential Life Skills for Students with Autism

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Tameika Meadows, BCBA, Blog Author

It's been way-y-y-y too long since my last audio post, so now seems like a good time for one focused on ABA Consultation, and being a Consultation C-H-A-M-P ;-)

ABA Consultation is an interesting animal that can be very different from the typical BCBA supervision or case management role, in terms of pay, workload, clients served, time demands/responsibilities, and on and on. I use the word "Consultant" specifically to mean an ABA professional who works independently (self-employed) to serve clients. 

There are many snares and barriers that can pop up and impede effective service delivery when consulting, and I am often contacted by ABA peeps confused if they are ready to wade into the consulting waters. There are many things to consider beyond the obvious question of possessing the clinical skillset to practice independently. To name a few: 

How to find clients, Where to advertise, How to bill for services, What materials to use, Ethical issues when joining multi-disciplinary teams, How to address contract violations, etc.


Two quick tips before you start listening to the audio post:

- Legally, a CPA and/or an attorney who knows the laws of your state would be the best person to answer specific tax, income/1099 filing, billing, etc. sort of questions when it comes to consultation.
- If you are located outside of the US, "consultation" may mean something completely different for you as an ABA professional. For my international readers, you may need to speak to professionals in your local area to determine how much of this information will be applicable for you. On that same topic, if you live in the US but consult with individuals outside of the US, you need to get familiar with differences in how ABA services can be provided in that location. 



You can download the presentation HERE, then just start the slideshow and the audio narration should run automatically.




* Resources for further learning:

"Soft Skills" related to successful ABA Consultation 

Consultation in Applied Behavior Analysis 

Functional Behavioral Assessments in Schools

School Consultation in Rural Areas

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Tameika Meadows, BCBA, Blog Author

*Recommended Reading:

Discrete Trial Teaching
Pre-Requisite Skills to Group Instruction
"Learning to Learn" skills 


One of the most important components of quality instruction, in addition to accurate assessment, ongoing data collection, and an individualized system of reinforcement, is the understanding of how Pre-Requisite Skills impact learning and progress.

Think of any skill you are trying to teach like a ladder. For some clients, moving from rung 2 straight to rung 5 is fairly simple, and for others that is nearly impossible. What is a logical mastery progression for one client, could cause another client to derail any progress gains. Skill acquisition is an art, and requires some serious fine-tuning at times in order to ensure the client continues to progress.

What cannot be left out of this conversation is the pre-requisite skills to what you are working hard to teach. Or, what is underneath what you are teaching. Have you broken the skill down as far as you can? Are you sure?

Some examples:

Teaching playing with toys according to function --> How many toys can the client interact with for more than a few seconds?

Teaching motor imitation --> Does the client attend? If not, how will they see the action to imitate?

Teaching a listener responder instruction ("sit down") --> How many adult demands does the client currently follow/Who else in the client's life is requiring sitting behavior?

Teaching play behavior through coloring/drawing --> Does the client interact with crayons/markers ever? Do they have any idea what to do with a crayon?

Teaching a vocal manding repertoire --> How many sounds does the client currently make per hour, if any? 



When designing intervention it can be quite overwhelming to decide where to start first, what skills should be prioritized, and which deficits are impacting the client the most on a day-to-day basis. BUT, once you start to examine the underlying skill deficits that are causing many responding errors, it gets much easier to streamline/maximize therapy sessions by focusing on those pivotal areas of learning that will positively impact other areas. 

When progress on a particular program or target stalls, regresses, or is inconsistent, beyond modifying prompt levels, reinforcement, or changing the stimuli, along with the suggestions below, it's a good idea to also focus on the skill(s) underneath the skill you are teaching:

• Examine the data closely, what kind of progress has the client made on the specific program/target over time?
• Are all the programs demonstrating need for troubleshooting, or just one particular program?
• Is it necessary to return to some previously mastered concepts? 
• Is therapy happening frequently enough/is the program being taught frequently enough?
• Is the teaching method consistent across the team?
• Watch the client carefully during teaching trials to learn about the types of errors that are occurring (or if non-responsiveness is occurring)
• (Super helpful tip) Observe a typically developing peer perform the specific target or skill. Compare that to how the client performs the target or skill. What's different/missing? 

Reference: (2005). A Model for Problem Solving in Discrete Trial Training for Children with Autism

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Tameika Meadows, BCBA, Blog Author