Category Archives: Q&A

How do you figure out what motivates your students?

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This ASAT feature comes to us from Niall Toner, MA, BCBA of the New York State Institute for Basic Research in Developmental Disabilities. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

I am a special education teacher working with students with autism. At times I find it difficult to figure out what motivates my students and what they’re interested in. Can you make some suggestions about the best way to do this?

This is an excellent question and one that highlights a challenge often experienced not only by teachers but also by family members of individuals with autism. We know that the interests and preferences of individuals with and without autism vary significantly over time. Also, we know that effective teaching of skills and behavior change are predicated upon the timely use of powerful reinforcement (i.e., positive consequences of skilled behavior that motivate and strengthen that behavior). As discussed below, identifying an individual’s preferences is a critical first step in teaching new skills because these preferences often lead to the identification of powerful reinforcers; but how we do this can be easier said than done, especially when the learner has a limited communication repertoire or very individualized interests. The best way to identify preferences is through ongoing preference assessments.

The value of preference assessments

Since many individuals with autism may have difficulty identifying and communicating their preferences directly, we must consider alternative methods of obtaining this information. At the onset, it is important to keep in mind that what may be rewarding or reinforcing for one individual may not be for another. For example, one child may enjoy bubble play, crackers or a particular cause-and-effect toy while a classmate may find one or more of these uninteresting or even unpleasant. Furthermore, an individual’s preferences change across time. For example, an individual may have demonstrated little use for music at age 11, but she may demonstrate a keen interest in music at age 13.

Preference assessments provide a systematic, data-based approach to evaluating a host of potential interests (e.g., food, toys, activities) for an individual. Although preference assessments do require time and effort up front, their use can decrease the time and energy, required to change behavior in the long run. Research indicates that when caregivers use a presumed preference that, in fact, is not the learner’s actual preference, valuable time, energy and resources are lost (Cooper, Heron, & Heward, 2006).

Types of Preference Assessments

Preference assessment can be conducted in three distinct ways: (1) Interviews and Formal Surveys; (2) Direct observation; and (3) Systematic assessment.

Interviews are a straightforward technique that can be used to gather information quickly. They involve obtaining information from the individual’s parents, siblings, friends, and teachers (and
from the individual, if communicative) by asking both open-ended and comparison questions. Examples of open-ended questions include: “What does he like to do?” “What are his favorite foods?” and “Where does he like to go when he has free time?” Comparison questions might include: “Which does he like better, cookies or crackers?” and “What would he rather do, go for a walk or eat chips?” Resultant information is then compiled in a list and identified items and activities can be piloted out as possible reinforcers.

Formal surveys can also be used to guide these discussions. One widely used survey is the Reinforcement Assessment for Individuals with Severe Disabilities (RAISD; Fisher, Piazza, Bowman, & Amari, 1996). This interview-based survey gathers information about potential reinforcers across a variety of domains (e.g., leisure, food, sounds, smells), and ranks them in order of preference. It should be noted that, although simple and time-efficient, using interviews alone can result in incomplete or inaccurate information. In fact, some studies have shown that, for the same individual, staff interviews did not reveal the same information as using a survey (Parsons & Reid, 1990; Winsor, Piche, & Locke, 1994).

Direct observation involves giving the individual free access to items and/or activities that he or she may like (presumed preferences) and recording the amount of time the individual engages with them. The more time spent with an item or activity, the stronger the presumed preference. In addition, positive affect while engaged with these items and activities could be noted (e.g., smiling, laughing). During these observations, no demands or restrictions are placed on the individual, and the items are never removed. These direct observations can be conducted in an environment enriched with many of the person’s preferred items or in a naturalistic environment such as the person’s classroom or home. Data are recorded over multiple days, and the total time spent on each object or activity will reveal the presumed strongest preferences. Direct observation usually results in more accurate information than interviews but also requires more time and effort.

Systematic assessment involves presenting objects and activities to the individual in a preplanned order to reveal a hierarchy or ranking of preferences. This method requires the most effort, but it is the most accurate. There are many different preference assessments methods, all of which fall into one of the following formats: single item, paired items, and multiple items (Cooper, Heron, & Heward, 2006).

Single item preference assessment (also known as “successive choice”) is the quickest, easiest method. Objects and activities are presented one at a time and each item is presented several times in a random order. After each presentation, data are recorded on duration of engagement with each object or activity.

Paired method or “forced-choice” (Fisher et al., 1992) involves the simultaneous presentation of two items or activities at the same time. All items are paired systematically with every other item in a random order. For each pair of items, the individual is asked to choose one. Since all objects and activities have to be paired together, this method takes significantly longer than the single-item method but will rank in order the strongest to weakest preferences. Researchers found that the paired method was more accurate than the single item method (Pace, Ivancic, Edwards, Iwata & Page, 1985; Paclawskyj & Vollmer, 1995).

The multiple-choice method is an extension of the paired method (DeLeon & Iwata, 1996). Instead of having two items to choose from, there are three or more choices presented at the same time. There are two variations to this method: with and without replacement. In the multiple choice with replacement method, when an object is selected, all other objects are replaced in the next trial. For example, if the individual is given a choice of cookies, crackers, and chips, and he chooses cookies, the cookies will be available for the next trial, but the crackers and chips are replaced with new items. In the without replacement method, the cookies would not be replaced and the choice would only be between the crackers and chips. No new items would be available.

A few final recommendations

When conducting preference assessments, consider testing leisure items/activities and food assessments separately because food tends to motivate individuals more than toys and other leisure items (Bojak & Carr, 1999; DeLeon, Iwata, & Roscoe, 1997). Also, be sure to assess preferences early and often. Preference assessments should be conducted prior to starting any new intervention or behavior change program. And remember that preferences change over time and require continuous exploration. Therefore, assessments should be updated monthly or whenever an individual appears tired of or bored with the preferred items. Keep in mind too, that the identification of one type of preference may provide ideas for other potential reinforcers. For example, if an individual loves a certain type of crunchy cereal, he/she may like other cereals or crunchy snacks. Or if an individual enjoys coloring with crayons, consider exploring whether he/she may enjoy coloring with markers or using finger paints.

Finally, when selecting a preference assessment method, a practitioner or parent should consider the individual’s communication level, the amount of time available for the assessment, and the types of preferred items that will be available. Taken together, these preference assessment methods can provide the valuable information necessary to help motivate and promote behavior change in individuals with autism.

References

Bojak, S. L., & Carr, J. E. (1999). On the displacement of leisure items by food during multiple stimulus preference assessments. Journal of Applied Behavior Analysis, 32, 515-518.

Cooper, J. O., Heron, T. E., & Heward W. L. (2006). Applied Behavior Analysis (2nd ed.). Upper Saddle River, New Jersey: Prentice Hall.

DeLeon, I. G., & Iwata, B. A. (1996). Evaluation of multiple-stimulus presentation format for assessing reinforcer preferences.Journal of Applied Behavior Analysis, 29, 519-533.

DeLeon, I. G., Iwata, B. A., & Roscoe, E. M. (1997). Displacement of leisure reinforcers by food during preference assessments. Journal of Applied Behavior Analysis, 30, 475-484.

Fisher, W. W., Piazza, C. C., Bowman, L. G., & Amari, A. (1996). Integrating caregiver report with a systematic choice assessment. American Journal on Mental Retardation, 101, 15-25.

Fisher, W. W., Piazza, C. C., Bowman, L. G., Hagopian, L. P., Owens, J. C., & Slevin, I. (1992). A comparison of two approaches for identifying reinforcers for persons with severe to profound disabilities. Journal of Applied Behavior Analysis, 25, 491-498.

Pace, G. M., Ivancic, M. T., Edwards, G. L., Iwata, B. A., & Page, T. J. (1985). Assessment of stimulus preference and reinforcer value with profoundly retarded individuals. Journal of Applied Behavior Analysis, 18, 249-255.

Paclawskyj, T. R., & Vollmer, T. R. (1995). Reinforcer assessment for children with developmental disabilities and visual impairments. Journal of Applied Behavior Analysis, 28, 219-224.

Parsons, M. B., & Reid, D. H. (1990). Assessing food preferences among persons with profound mental retardation: Providing opportunities to make choices. Journal of Applied Behavior Analysis, 23, 183-195.

Windsor, J., Piche, L. M., & Locke, P. A. (1994). Preference testing: A comparison of two presentation methods. Research in Developmental Disabilities, 15, 439-455.

About The Author

Niall Toner MA, BCBA, LBA is a licensed behavior analyst and board certified behavior analyst with over 10 years experience working in the fields of applied behavior analysis and developmental disabilities. Niall is currently the Clinical Director for Lifestyles for the Disabled. Prior to the position he served as a consultant to various organizations including the New York City Department of Education. He also held the position of Assistant Director at the Eden II Programs. Niall has presented locally, nationally and internationally. His interests are Preference Assessments and Functional Analysis, which he presents and publishes.

Originally reposted to Different Roads to Learning on September 28, 2017

ABA Journal Club #7: Choice Within Token Systems

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One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

I frequently use the Functional Assessment Interview (O’Neill, Albin, Storey, Horner, & Sprague, 2015) when beginning to assess the function of problem behaviors. One of my favorite questions in this assessment relates to how frequently the individual has choice during the day. Many of the individuals I work with are provided very few, if any, choices during the day. This is one of the first things I often work to change.

The article for July’s ABA Journal Club assesses choice within token systems. This is only one way that choice can be implemented throughout the day, but it’s a nice jumping-off point for discussions of how to increase choice for your clients or students.

Sran, S. K., & Borrero, J. C. (2010). Assessing the value of choice in a token system. Journal of Applied Behavior Analysis, 43(3), 553-557

  1. Why did the authors select to focus on choice within token systems? How is this relevant to your current work environment?
  2. Discuss the procedure used in this research. How could you replicate these procedures with your own clients?
  3. The preference for the opportunity to make choices within the token system varied across individuals. How does this impact treatment decisions you would make for your clients?
  4. How do you currently incorporate choice with the individuals you work with?
  5. What changes can you make in incorporating choice with the individuals you work with?
  6. This article discusses the use of ABA strategies for individuals who do not have autism. Why is this important for us to consider?

O’Neill, R. E., Albin, R. W., Storey, K., Horner, R. H., & Sprague, J. R. (2015). Functional assessment and program development. Nelson Education.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

ABA Journal Club # 6: A Response From Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS

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One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

This month’s response comes from Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS. Sam’s original blog can be seen here.

  • How does Skinner’s definition of culture differ from how you typically consider culture?

Fong: I think that Skinner did a nice job of linking a person’s actions and beliefs within the context of their environment.  At times, I feel it’s an oversimplification of a term, and behavior analysts should explore (on a deeper level) what that means. It defines culture, but lacks in helping us to understand it, or on a more practical level, what this means for our practice of ABA. I’m in agreement that our histories and the contingencies that we come into contact with shape who we are.  But as clinicians, what does this mean? When I think of culture, I consider things like history, contingencies and the environment in which the person operates, but I also try to draw out more information about what this means for my work as a clinician – if at all.  Culture is deep and rich, and sometimes I feel that relying on just Skinner’s definition doesn’t take all this into consideration. We can take that as a starting point, on how to conceptualize culture, but we need to go further into truly trying to understand what it is. Some interesting articles to review on the topic are: Muchon de Melo, C., & de Rose, J. C. (2013). The concept of culture in skinnerian Radical Behaviorism: Debates and controversies. European Journal of Behavior Analysis, 14(2), 321-328; Glenn, S. S. (2004). Individual behavior, culture, and social change. The Behavior Analyst, 27(2), 133-151.

  • Have you encountered situations in which by cultural contingencies impacted an intervention you planned? What might you have done differently if you could go back in time?

Catagnus: I’d like to share the story of two of my colleagues, Stacee Leatherman and Ashley Knochel. They are both doing really important work in this area that exemplifies this issue. And, you’ll likely see their papers on the topics published soon, so this will be a preview. Stacee was a therapist working with a family from a different country that had immigrated to her local area. She reported at a recent ABAI conference event that she felt ill-prepared by her behavior analytic training to adequately assess and intervene in a culturally appropriate way. The family ultimately left ABA services, and Stacee went to the literature to see what their consulting group could have done to better serve the family. She found almost no relevant empirical research in ABA journals that addressed implementation or culturally adapted interventions with non-Western families of children with Autism. We recently submitted a manuscript presenting her findings and making some recommendations of our own.

Leatherman, S., Catagnus, R. M., Brown, T. W., Moore, J., Torres, I. (2019). A systematic review of strategies to improve treatment services provided by cross-cultural practitioners working with individuals with autism spectrum disorder. (Manuscript in preparation).

Ashlee, along with co-researchers, has conducted one of the rare empirical studies of ABA with non-Western learners (and is submitting this manuscript soon). She was working in Ghana at a school for children with ASD. She helped the teachers implement a common behavior analytic technique, behavior specific praise. She did so in a way that is typical here in her culture in the US, in terms of using language to label the behavior, specifically, vocally, and with excitement. For cultural reasons, the way she’d learned to conduct the procedure in her culture caused a decrease in the desired behavior of working on task! So, she met with the stakeholders in the setting, engaged in culturally sensitive and humble question asking, and was able to collaboratively identify why the commonly used approach was not culturally appropriate or helpful – why it was detrimental to learning. Together, they revised the way the reinforcement was delivered, assured it was culturally correct, and the on-task behavior improved, and the staff reported feeling that Ashley’s interactions were culturally relevant. The outcome, and consultation process, was impactful. This is some of the first empirical data I’ve seen to explain how ABA interventions repeated ‘the way we learned to do them in our own culture’ can negatively impact those we service if we don’t approach the planning and implementation in a culturally interactive and open way.

Knochel, A., Blair, K. C., Sofarelli, R. (2019). Culturally focused classroom staff training to increase praise for Ghanaian students with autism spectrum disorders. (Manuscript in preparation).

  • Do you currently engage in any of the suggestions the authors provide for self-reflection? What has been your experience with self-reflection?

Catagnus: I regularly engage in self-reflection in the forms of mindfulness practice and formal meditation. In fact, I developed a mindfulness and ABA course at TCSPP and get to regularly talk about this with our students. I think and talk about my own cultural frameworks and background regularly, too, because of the types of research and implementation we conduct for culturally relevant pedagogy at the University. Luckily, the work that I do is immersive in terms of cultural topics, and I continue to develop my self-awareness. I also seek out experiences of diversity, by traveling, engaging in study abroad programs for myself and creating them for my students. I’ve worked with amazing local early educators in South Africa, visited cultural and academic sites in Denmark, taken classes in Spain, and am about to do visit Singapore, Malaysia, Vietnam, and Qatar. Developing relationships with people around the world has helped me stay reflective and to grow personally and professionally. Learning never stops for this process.

  • Do your current functional assessments incorporate cultural variables? If not, what can you change to improve your functional assessment process?

Fong: I do not think most FAs incorporate cultural variables. While the principles of ABA might be considered to be universal, the way in which we complete an FA is very Eurocentric.  Most of the places I have worked at present the FAI in English and if another language is required a translator is used. The translator may or may not have the clinical understanding to accurately communicate the question. Also, some of the questions are more direct, closed ended.  Some culture may do better by telling a story. Generally, there are no questions that directly address culture – for example, preference on pronouns, holidays, languages used, the role of the clinician in the family’s mind, background information about caretakers, what behaviors are reinforced/valued by a culture and which are not, etc.  I think incorporating things like this, into FAs would help to make them more culturally sensitive. Maybe each culture, create their own? I will ask clients if there is thing anything else that they feel that I should know, which might be relevant to intervention. Sometimes I prompt for information about language, holidays, manners, norms, preferences, etc. A good article on the topic is: Tanaka-Matsumi, J., Seiden, D. Y., & Lam, K. N. (1996). The Culturally Informed Functional Assessment (CIFA) Interview: A strategy for cross-cultural behavioral practice. Cognitive and Behavioral Practice, 3(2), 215-233.

  • One of the recommendations by the authors is to use readily available resources. What resources are available to you? How can your organization better provide resources to help behavior analysts address cultural variables?

Fong: I like this family therapy book – McGoldrick, M., Giordano, J., & Garcia-Preto, N. (Eds.). (2005). Ethnicity and family therapy. Guilford Press. The Special Interest Groups (SIG) of ABAI are another good resource, I’ve found that people are responsive if you email them questions.  There is also the Culture and Diversity SIG of ABAI. I also tend to look outside the ABA, to fields such as psychology, who have done a superior job addressing the need to examine the role that culture plays in treatment. Recently, there has been an increase in behavior analytic articles and presentations addressing culture, so I try to read those.           

Catagnus: TCSPP has an institutional learning outcome related to diversity, so we embed learning, resources, assignments and outcome measures throughout our program. It is a deeply held value and a strong focus of our program. For this reason, our students often research topics related to culture, diversity, and inclusion. They have access to carefully curated curricular materials like articles, books, lectures, and tutorials on many different related topics. Our classes are regularly evaluated and updated to represent more global perspectives. And, the process of students’ learning is supported from the day they start until graduation, with the goal of developing their own resources and skills in cultural awareness. We are also implementing some innovative advising and learning laboratory programs to further help students connect with personal resources for cultural competence.

  • The authors suggest the use of social validity surveys as one method for addressing cultural values. How can you incorporate this into your current practice?

Fong: I think, by just asking a client/family member/guardian if they agree with the goals and treatment suggestions would be a good start. Incorporating more relevant people into intervention planning would also be a good step.  I tend to get better participation in data collection when I do this, as well (i.e. buy-in).

Catagnus: Bobbie Gallagher and a few of us from TCSPP recently published a paper that addressed the cultural values of females with limited language (LL) and autism (ASD), and their families and nurses. The study was designed to gather social validity about what strategies would be doable, preferable, and acceptable to communicate with women with LL and ASD during a gynecological exam. These women are at risk because, statistically, they don’t access this important health service very often, if at all. The study gathered quantitative and qualitative data about concerns, fears, and preferences for how women could be more effectively and respectfully involved in the process of a diagnostic exam. As Bobbie wrote, “Identifying strategies with a higher rate of social validity, or acceptance of treatment prior to implementation, may assist future researchers in conducting studies on the effectiveness of those strategies.”

Gallagher, B.J., Flynn, S.D., Catagnus, R.M., Griffith, A. (2019). Social validity of strategies to assist females with ASD during gynecological examinations. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-018-9654-5

  • The authors state that one limitation of their article is that they did not provide systematic guidelines for working with culturally diverse clients. If you were going to introduce such guidelines, what might you include?

Fong: I think the guidelines I referenced here: Hughes Fong, E., & Tanaka, S. (2013). Multicultural Alliance of Behavior Analysis Standards for Cultural Competence in Behavior Analysis. The International Journal of Behavioral Consultation and Therapy. 8(2): 17-19. Are a good start.  APA did a fantastic job on their guidelines – so again looking at other fields to see what they have done (https://www.apa.org/about/policy/multicultural-guidelines) and learning from other fields would be helpful.

Catagnus: Ashely Knochel, Kwang-Sun Blair, Stacee Leatherman, and I are working on a manuscript now related to this topic. We hope to provide the ABA community with a systematic review of relevant cultural adaptation models, highlighting one that is most useful as a framework to guide the process. We recommend that ABA look to other fields that have created and researched frameworks or developed guidelines. Examples include Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations from the APA, and AMA Code of Medical Ethics’ Opinion on Cultural Sensitivity and Ethnic Disparities in Care.

About The Authors

Dr. Robyn Catagnus is an expert on learning and behavior change. A board-certified behavior analyst, she is an associate professor, associate chair, and former national chair of Behavior Analysis at The Chicago School of Professional Psychology. She’s owned and operated a successful behavior consulting firm and held executive roles in behavioral health and educational technology organizations. As a management consultant and researcher, she also develops human capital initiatives to improve organizational behavior.

Dr. Catagnus’ helps educators promote inclusion, success, performance, and growth. She is a trustee of the Cambridge Center for Behavioral Studies; reviewer for the Diversity in Behavior Analysis section of the APA journal Behavior Analysis: Research and Practice; reviewer for Behavior Analysis in Practice, and former member of the editorial board for Perspectives on Behavior Science. Dr. Catagnus has degrees in instruction and technology, education, leadership and strategy, and a certificate in mindfulness.

Ms. Hughes Fong has over two decades of experience in the fields of behavioral health, education, and management. Her educational background is in clinical and counseling psychology and applied behavior analysis. She is currently a PhD candidate studying Clinical Psychology with a concentration in Forensic Psychology.

In 2011, Ms. Hughes Fong founded Multicultural Alliance of Behavior Analysts (MultiABA), now call the Diversity and Culture SIG. This is a special interest group of the Association of Behavior Analysis International (ABAI). Ms. Hughes Fong is the founder of “Diversity in Behavior Analysis” a section in Behavior Analysis Research and Practice, and serves as an Associate Editor for the journal. Ms. Hughes Fong, also serves on the Executive Committee for the American Psychological Association’s (APA) Division 35, as the Website Coordinator. She has been a reviewer for Behavior Analysis: Research and Practice, Behavior Analysis in Practice, and the National Multicultural Conference and Summit. She is also a “Distinguished Scholar” with the Cambridge Center for Behavioral Studies, and a member Association for Behavior Analysis International (ABAI)  Diversity, Respect, and Inclusion Task Force

In addition, to Ms. Hughes Fong activities, she is a Board-Certified Behavior Analyst and licensed as a Behavior Specialist in Pennsylvania, a trainer in the Pennsylvania Bureau of Autism’s Functional Behavior Analysis training, and has received training certificates in the area of Trauma-Focused Cognitive Behavior Therapy and Trauma-Focused Cognitive Behavior Therapy Childhood Traumatic Grief. In addition, she received her level one certification in Pivotal Response Training and Gottman Couples Therapy. Her primary areas of interest are in the application of ABA to multicultural populations, telehealth, social validity, health and behavior analysis, and examining child custody and parental competency when a child has developmental disabilities.

ABA Journal Club: Interventions and RBTs (response)

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One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

This week, Solandy Forte, PhD, LCSW, LBA, BCBA-D provided a response to some of Sam’s questions about the article below:

I am thrilled to contribute to the conversation about RBT as it deserves the attention particularly as we continue to grow as a field.  We are a young field that is experiencing growing pains but they are good ones.  I appreciate the contributions that many practitioners in our field have shared relating to credentialing of RBTs.  At the end of all this, I am confident we will have established training and experience standards to will lead to positive outcomes for our consumers.  We have a long road ahead. 

Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., … & Volkmar, F. R. (2017). Concerns about the Registered Behavior Technician™ in relation to effective autism intervention. Behavior Analysis in Practice, 10(2), 154-163.

  • The authors discuss the evolution of the BACB and concerns with certifying behavior analysts prior to the advent of RBTs. What did you think of the concerns identified here? Are these still concerns we have about BCBAs? How are they similar or different than concerns about RBTs?

The field of behavior analysis is practically in its adolescence.  There are many other helping professions such as psychology, psychiatry, and social work that have experienced growth for over a century and have had to navigate through barriers impacting the practitioner’s ability to provide quality behavioral healthcare with the increasing demand of service.  It is not unusual for a growing field to consider identifying ways to meet the healthcare needs of the population particularly when the number of qualified practitioners is not sufficient to meet the demands.  For instance, in the nursing field, registered nurses are often supported by nursing assistants and nurse aides.  The nursing field developed training and experience standards for each of these credentials and these standards have likely been modified as the profession has studied the impact on the overall delivery of services and its impact on the patient. 

Sure, the concerns raised are valid and should be evaluated carefully by researchers so that they can inform special matter expert groups established by the BACB®.  However, the field of behavior analysis cannot ignore the obvious increase in demand for applied behavioral analysis services.  It will take decades for the field to assess what are the most appropriate training and experience requirements to promote optimal consumer outcomes.  This is not only the case for RBTs® but also for BCBAs®.  Again, this is a growing field and we should expect to see modifications in the credentialing requirements. 

  • How does the current training of RBTs compare to the training of behavior technicians in early behavior analytic studies?

Any training of behavior technicians in early studies were developed by science practitioners who based their training procedures (e.g., topics, hours, teaching methodology, etc.) on either previous studies that evaluated training methods or training procedures that best fit their setting, staff, and client needs.  These research studies were not evaluating the training requirement of the RBT®.  Regardless, these studies contributed to the field of behavior analysis particularly when practitioners were developing in-house training requirements and adjusting along the way as they observed the behavior technician’s ability to implement behavioral technology with fidelity and retain what they had learned in the initial training overtime.  Currently, research studies are evaluating training packages that are aligned with the RBT® requirements and these will contribute to any revisions to credential requirements. 

  • Look at the RBT task list. The authors argue that the current amount of training does not meet standards set forth by research on staff training. How can BCBAs and organizations hiring RBTs support their mastery of the skills on this list?

Every organization is responsible for setting their own standards with regard to training of staff.  Training requirements will vary depending on the setting and in some cases requirements will expand beyond RBT® training.   For instance, there are organizations that require staff to receive physical management training, CPR, and first aid, to name a few.  It is common for training to occur on a regular or annual basis for an organization to remain in compliance with state regulations or enhance the delivery of services.  With regard to the RBT® credential, organizations are responsible and should carefully evaluate mastery of skills.  Further, organizations should include in their training protocols procedures for evaluating generalization and maintenance of acquired skills.  It is not only to important to meet mastery for each item on the RBT® task list but it is critical for staff to implement the skills they have acquired in a variety of setting over time.  RBTs work a variety of settings including home, school, and community; therefore, mastery of skills cannot just be mastered in the classroom setting but also must be generalized to the settings in which will be applied. 

  • Many of the recommendations by the authors include changes the BACB should enact as well as research that should be conducted. How are you able to take a role in these types of recommendations?

There is no doubt that research should be conducted to further evaluate the training and experience requirements for RBTs® but again this is going to take time.  Research studies take years to plan, execute, and disseminate.   This is not an easy feat but one that should be charged by the practitioners in the field and the demand for the delivery of high-quality behavioral services.  Our goal is to contribute to the solution by collecting and sharing data that experts can use to revise RBT® requirements.  We cannot ignore the obvious need for research in this area that will ultimately contribute to the positive growth of our field. 

Solandy Forte, PhD, LCSW, LBA, BCBA-D, is the Director of Consultation Services and Community Outreach at Milestones Behavioral Services.  She is a doctoral level Board Certified Behavior Analyst licensed in Connecticut and Massachusetts and a Licensed Clinical Social Worker.  Dr. Forte provides consultation services to the school programs at Milestones serving individuals with a diverse set of complex learning needs.  In addition to providing direct consultation to children within the private school setting, she also has provided consultation to multi-disciplinary teams within the public school setting where she assisted with program development initiatives to promote building capacity for educating children with autism and related neurodevelopmental disorders within the least restrictive educational setting.  Dr. Forte has experience working with children and young adults with special needs in their homes, schools, and community settings. She is an adjunct professor for the Institute of Autism and Behavioral Studies at the University of Saint Joseph in West Hartford, Connecticut and the Institute of Behavioral Studies at Endicott College in Beverly, Massachusetts. 

Journal Club #4: RBTs and Interventions

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One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, Ph.D., LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

In my daily work, I supervise Registered Behavior Technicians (RBTs) who are providing the direct care to my clients with autism. The RBT designation is only a few years old, and there are concerns about the training and maintenance of skills for these employees. However, another concern is the low number of people available to provide frontline services for high number of individuals who require it.

The work that RBTs do is important and necessary. It’s important for our field, as well as individual organizations and BCBAs to identify potential problems with the current model of providing treatment, and work to continuously improve upon the model. One way to start the conversation within your own organization is to read the following article and identify ways in which you can address the concerns it brings to light.

Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., … & Volkmar, F. R. (2017). Concerns about the Registered Behavior Technician™ in relation to effective autism intervention. Behavior Analysis in Practice, 10(2), 154-163.

  • The authors discuss the evolution of the BACB and concerns with certifying behavior analysts prior to the advent of RBTs. What did you think of the concerns identified here? Are these still concerns we have about BCBAs? How are they similar or different than concerns about RBTs?
  • How does the current training of RBTs compare to the training of behavior technicians in early behavior analytic studies?
  • Look at the RBT task list. The authors argue that the current amount of training does not meet standards set forth by research on staff training. How can BCBAs and organizations hiring RBTs support their mastery of the skills on this list?
  • Have you identified concerns with the current model (BCBAs supervising RBTs who provide direct care) that were not mentioned in the article? If so, how have you worked to address those concerns?
  • Discuss the unintended consequences described in the article. Have you seen these consequences in your current setting?
  • Many of the recommendations by the authors include changes the BACB should enact as well as research that should be conducted. How are you able to take a role in these types of recommendations?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

The founder of ABA Journal Club, Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

Ask A BCBA: I’m a Brand-New BCBA! What Should I Expect??

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Ask A BCBA is a new series where we take your questions to our favorite ABA professionals. Do you have a question for a BCBA? Email us at info@difflearn.com and you could be featured in a future post!

Congratulations on passing your BACB exam!  Not only did you pass this notoriously difficult test, but you completed hundreds of hours of graduate coursework and supervised experience to get to this point.  You had to have been dedicated and hard-working.  You have demonstrated your knowledge to your supervisor(s) and on a written exam.  You should feel proud!

You are now entrusted with the tools to change behavior, shape new skills, and make lives better.  Make no mistake, this is a big responsibility.  As a BCBA, you are expected to be proficient in all of the skills of a behavior analyst (as per the BACB task list) and to abide by the BACB Code of Ethics.  Part of the ethical code is that there is no excuse for not knowing the ethical code.

Some new BCBAs feel overwhelmed by their new responsibilities.  This is completely normal, and not a bad thing if it leads you to approach your new position with respect and caution.  Here are some suggestions for easing this transition and building your confidence.

  • Maintain contact with your supervisor or another mentor.  Most supervisors are happy to continue to have some continued less-structured contact to provide guidance.  Other seasoned BCBAs in your community might also be open to providing some informal mentoring.
  • Join a community of other BCBAs.  There are so many options for how to do this.  Joining your state ABA association is an excellent idea if you haven’t done so already.  If you are a social media person, there are many Facebook groups for BCBAs.  Other BCBAs at your job may want to connect, too.
  • Keep your resources handy.  Yes, I realize that you probably never want to see “The White Book” again – at least for a while – but don’t be afraid to look something up if you’re not sure.  Although you passed the exam, you may still need a refresher on less-familiar concepts when they come up in your work.
  • Start collecting CEUs!  Yes, now!  You need to document at least 32 CEUs every 2 years, so don’t fall behind.
  • Subscribe to journals.  JABA is not expensive, even when you are no longer a student, and you may not have access to your university library anymore.

Some new BCBAs feel overwhelmed by their new responsibilities.  This is completely normal, and not a bad thing if it leads you to approach your new position with respect and caution.  Here are some suggestions for easing this transition and building your confidence.

Remember that learning is a lifelong journey.  Even though you have made an amazing accomplishment, you aren’t expected to know everything.  Take the energy and enthusiasm that got you to this point, and use them to continue to develop your skills and your network.  As B.F. Skinner wrote in Walden Two, “It is not a question of starting.  The start has been made.  It’s a question of what’s to be done from now on.”  The hard part is over, so go ahead and make the most of your accomplishment!

About The Author

Dana Reinecke, Ph.D., BCBA-D is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is a Core Faculty member in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities.  She has presented original research and workshops on the treatment of autism and applications of ABA at regional, national, and international conferences.  She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA).

ABA Journal Club #3: Functional Analysis

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One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

Head to our Facebook page to join the discussion and let us know your thoughts!

When I was first starting out in behavior analysis, I was amazed at the simplicity and accuracy of functional analysis. Behaviors that had seemed complex and impossible to change suddenly made sense. I felt ready to create interventions to address those behaviors, and started to see more success in my behavior change procedures. Functional analysis remains one of my favorite topics to teach, and one of the questions I get most often from my graduate students is about ethical concerns in relation to completing a functional analysis for potentially dangerous behaviors. 

This has been a concern in the field, and there is a strong evidence base that identifying, assessing, and treating precursor behaviors is effective in reducing the target problem behavior. For this month, I have selected a paper on this topic.

Herscovitch, B., Roscoe, E. M., Libby, M. E., Bourret, J. C., & Ahearn, W. H. (2009). A procedure for identifying precursors to problem behavior. Journal of Applied Behavior Analysis, 42(3), 697-702.

What is the purpose of the current study? How is it relevant to your current work?

The researchers used both indirect and descriptive methods for identifying precursor responses. What were these methods?

Describe each of the probability measures the researchers used. How were these related to each other? Could these be used in your current setting?

What did the authors find was most probable to occur prior to head-hitting behavior? Why is this information important?

When the researchers conducted the functional analysis on the precursor behavior, was the head-hitting behavior eliminated? Why is this important to recognize? What implications does it have for practitioners?

Identifying the precursor behavior can decrease risk resulting from problem behaviors such as self-injurious behavior or aggression. Can you identify a current problem behavior for one of your clients and create a plan for determining precursor behaviors?

Please note that this particular study has only one participant. Sometimes, behavior analysis as a field is criticized for the use of single-subject studies. You can read this previous post  for more on the topic of single-subject studies.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

The founder of ABA Journal Club, Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

ABA Journal Club #2: Ethics and Social Media

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One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

Head to our Facebook page to join the discussion and let us know your thoughts!

It is important in our field to maintain an open conversation about ethics. The Professional and Ethical Compliance Code outlines how behavior analysts are expected to conduct themselves, but sometimes situations are not so black and white. And as the world changes, so do the expectations for ethical conduct. In recent years, issues related to social media have been especially relevant. This month, I’ve selected the following article which addresses the special concerns that come up with the use of social media.

O’Leary, P. N., Miller, M. M., Olive, M. L., & Kelly, A. N. (2017). Blurred lines: Ethical implications of social media for behavior analysts. Behavior Analysis in Practice, 10(1), 45-51 .

  1. The article reviews the codes of ethics for other professions. Why is this valuable for us to do as a profession? Did you learn anything surprising or interesting form this portion of the article?
  1. Since this article was written, our field has a new Professional and Ethical Compliance Code. How does this code differ from the previously used Guidelines for Responsible Conduct? What aspects of the code directly apply to ethical situations related to social media?
  1. “A search on an internet search engine for information related to a procedure or scientific concept may yield results as to what that procedure or concept is. The same search on a social media outlet may yield results as to whether or not that procedure or concept should be used (p. 47.) Discuss this difference.
  1. Behavior analysts and others interested in the topic may turn to social media to get answers to their questions due to the low response effort involved and the speed of reinforcement. How can we decrease response effort and increase reinforcement for referring to the scientific literature to answer our questions?
  1. The authors provide suggestions for how behavior analysts should behave on social media. Are there any suggestions you might add? Are there ways you can increase the likelihood of other behavior analysts following these suggestions?
  1. Consider your own behavior on social media. Based on recommendations from the article, what is one change you can make to increase your own ethical behavior in this context?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

Curriculum Guides For Older Learners

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This month’s ASAT feature comes to us from Dr. Kirsten Wirth, C.Psych., BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

My child is older now and the early years curriculum guides we have used (e.g., the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) and Verbal Behavior Milestones and Placement Program (VB-MAPP)) are no longer appropriate. How should we plan for his future and current goals?

Answered by

Kirsten Wirth, C.Psych., BCBA-D

Wirth Behavioural Health Services

There may be some good curricula that can be used at an older age (e.g., Partington’s Assessment of Functional Living Skills (AFLS)).  Curricula like the AFLS include measuring basic living skills, vocational skills, home skills, community participation, and independent living skills.  That said, there are several reports that highlight areas to consider in programming for any individual.  Peter Gerhardt (2009) developed a paper that covers what services are available for adults with autism spectrum disorder (ASD) and considerations that should be made. The Drexel Autism Institute put out a report discussing transitions into adulthood (Roux, Shattuck, Rast, Rava, & Anderson, 2015). This question will be answered using information from both reports as well as clinical experience working with children and adults with ASD over the past 18 years.

Both reports highlight the importance of starting early.  For example, on average, transition planning and working towards future goals should begin by 14 years of age, although in some states this may happen earlier.  In many high schools and programs this type of planning happens much later, but the reason 14 years is recommended is because it can take several years to teach job or recreational skills, as well as any skills that need to be taught well before the ultimate desired outcome.  Also, more time allows for assessing and incorporating changing and developing interests over time. It is ideal that all these skills are incorporated into the students’ school program.  Skill areas may include planning for a vocation, post-secondary education, recreation and leisure, community safety, transportation, vacationing, health and wellness, sexuality instruction, handling crisis and interacting with first responders, daily living, and communication.

Where to start? Start by thinking and talking with the individual, family, and staff involved that know the individual best. Think about each area and explore what the individual might be interested in 5-10 years down the road as a team. Once all the ideas are jotted down, start discussing what should be chosen to target or to explore further. Keeping in mind you should weed out things that are not realistic but keep things that may be a stretch.  How do you know if it is realistic or not?  Having a detailed and current assessment of the individual’s abilities and skills is helpful.  For example, if an individual has intellectual and adaptive scores at or near the average range, a traditional college education may make sense and they may not need goals set in post-secondary education.  However, making friends and enjoying leisure and recreation may be an area of weakness so goals should be set in those areas.  As another example, if an individual has very low intellectual and adaptive scores, a college education may not make sense, but a part time job and skills around that job may need to be learned. Most importantly, goals should be set incorporating the individual’s existing skills, preferences, and interests.

Vocational goals: Is the individual able or interested in part-time or full-time work?  If he is still in school, can he work part-time?  What kind of work can he do independently right now?  What kind of work is he realistically capable of gaining skills in during the next 5-10 years?  Sometimes exploring different types of work through volunteer experience can be set up either with a one-on-one support person, or just on his own.  If skills need to be taught, how much should they be broken down for the individual to perform all skills independently?  Can all skills be taught at the same time or one at a time?  For example, if he is going to do custodial work at a local small hotel, this might include vacuuming the hallways; sorting, putting laundry through the washers, and folding; sweeping up the breakfast area; and making small talk or hanging out during breaks.  Each skill may need to be taught explicitly or not, dependent on the individual. Sorting laundry may include teaching matching skills and sorting skills before applying to daily life; or, many of these tasks could be taught by practicing in the school or leisure program on a regular basis.  Making small talk or engaging in conversation during break may require setting goals in social skills and communication areas as well. Taking direction from supervisors or others in authority and learning how to ask appropriate questions might be another area of consideration.  How will the individual get to work? Is he able to learn to drive a car to get himself there? Should a bus route and taking the bus be taught?  Driving or even using transportation might have multiple steps to learn, especially if there are construction detours, or changes to timing that would have to be checked regularly.  Do the vocational goals require further education?  Do money concepts have to be taught? Counting out change? Entering an order into a computer system?

Post-secondary Education goals: Does the individual have any special skills or strengths that should be considered?  Is the individual interested in a trade?  Business?  Graduate school?  If the individual could realistically perform a job in their area of interest down the road, do goals need to be set for pre-requisite subjects at the high school level – even if it may take longer to meet them – such that entry requirements can be met?

Recreation & Leisure goals: What kinds of interests does the individual already have during downtime?  Are interests limited?  Developing new preferences might be required. This might include providing repeated exposure to new places or activities to see if the individual enjoys them, or providing additional reinforcement for participating in them.  Do any barriers exist to participating in the new experiences?  Does any desensitization (e.g., exposure to certain sounds or experiences in the environment while preventing problem behaviour) have to occur before going on outings?  Are there refusals or problem behaviours to be decreased?  If so, goals should be set in those areas as well.  Does he or she need help with setting goals to earn a specific amount of money to go on a desired vacation or attend an event?  Does the individual have a regular group of friends to attend events or hang out with?  Do friendships need to be established?  Are social and communication skills related to making friends required to be learned first or during?  Should the individual get a ride with friends?  Take the bus?  Drive and offer to pick up friends?  Establish a meeting place at the event with friends?

As you may have noticed, many of the areas described above overlap with social and communication areas, transportation, and others. Goals naturally should be set in each area to appropriately encompass all skills needed in one’s day-to-day life. Remember the other areas as well; i.e., health and wellness (e.g., exercise, healthy eating, good hygiene), sexuality instruction (e.g., how to have sex, when to have sex, protection from disease and pregnancy), daily living skills (e.g., laundry, cooking, shopping), and so on. Happy planning!

References

 

Gerhardt, P.F. (2009). The current state of services for adults with autism. Arlington, VA: Organization for Autism Research.

Roux, A.M., Shattuck, P.T., Rast, J.E., Rava, J.A., & Anderson, K.A. (2015). National Autism Indicator Report: Transition into young adulthood, Philadelphia, PA: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University.

About The Author 

Dr. Kirsten Wirth (C.Pysch., BCBA-D) is a licensed psychologist and board certified behavior analyst-doctoral with a PhD in Psychology – Applied Behaviour Analysis (ABA) from the University of Manitoba. She is an Advisory Committee Member, Founder, and a Past President of the Manitoba Association for Behaviour Analysis (www.maba.ca). Dr. Wirth is the Co-Coordinator of Clinical Corner for the international organization, the Association for Science in Autism Treatment (www.asatonline.org). She is also the author of “How to get your child to go to sleep and stay asleep: A practical guide for parents to sleep train young children.” Dr. Wirth has 18 years experience working with children, adolescents, and adults, with or without developmental disabilities and autism using, teaching, and training others to use ABA. She provides screening and diagnostic assessment for children with autism, early intensive behavioural intervention (EIBI/ABA) programming to children with autism and their parents, or intensive behavioural intervention (IBI) for older children or adults with autism or developmental disabilities. Dr. Wirth also conducts assessment and treatment of severe problem behaviour, child behaviour management, parent coaching, sleep assessment and coaching, toilet training, social skills training, skill building, school or daycare consultation, and more, for children with or without psychiatric diagnoses. Dr. Wirth has been an invited speaker and presenter at local and international conferences and is a co-investigator of a number of research projects including comparison of comprehensive early intervention programs for children with autism and comparison of prevalence rates and factors related to delayed diagnosis.

Managing a Home-Based ABA Program

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This month’s ASAT feature comes to us from Beverley Sharpe, a founding member and Director of Families for Early Autism Treatment of B.C. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

We have a home-based intervention ABA program for our son. What are some helpful suggestions for managing the steady stream of professionals in our home?

Answered by Beverley Sharpe, parent of a 22- year-old daughter with autism

Opening your home to therapists, behavioral consultants, and other providers is part of effective treatment for your child. However, it can sometimes be difficult to supervise a home that doubles as a work environment and the many opportunities and challenges that come with that arrangement. I am humbled by the high level of energy and dedication my therapy teams, past and present, have demonstrated within my own child’s program. Teamwork and collaboration are crucial elements to make home therapy effective. The following are some helpful tips I’ve learned over the years to help make home team coordination more manageable.

Be a Good Host/Hostess

I have struggled at times to balance being a “boss” and a “hostess” within my home. At the start of a shift, I recommend a five-minute exchange to greet and debrief the provider. No matter what job one has, people deserve to be acknowledged and greeted. I typically put on the tea pot or provide a cold drink, say hello, debrief, then let the provider begin the shift. With a new provider, I allow more time for him or her to set up materials, reinforcers, and data sheets before bringing in my child.

Define Your Expectations of Those Who Work with Your Child

An agency that provides home-based intervention will have a written job description or list of expectations for employees. If you are not working with an agency but are, instead, hiring and training your own team, please take the time to put important expectations in writing. Being on time, completing data sheets, communicating about behaviors observed, being prepared for shifts (including bringing appropriate task and reinforcer materials), and respecting other family members are examples of appropriate expectations.

Get Feedback from Staff

Over time I learned to explain to the team that it is hard for me to be both a boss and a friend. I truly did want to be a good listener, and at the same time a good manager of the team. I enjoyed the one-on-one time at the beginning of a shift with each provider and would ask, “How are you?” and “How are you finding the work with my child?” Their answers inspired me to make changes to the program, address issues with the behavioral consultant, and work on team building during team meetings that became more frequent when my daughter’s inappropriate behaviors became challenging.

When conflicts of any kind arise, talk about it and clear the air so that tensions or misunderstandings do not fester. Speaking about problems factually, face-to-face, with a hot cup of tea or coffee is a strategy that I have used. Also, I would make sure my daughter was engaged in an activity before starting the conversation. Remember, you can control yourself, your communication style, and the environment when you address an issue. Being respectful, honest and kind are great ways to be sure you have done your best to address issues. In my experience, new directions have come from allowing members of the team to share their perspective with you. Your child’s quality of life depends on effective intervention, and a home that is warm and inviting to the hard working providers who share your vision will help your son realize his fullest potential.

Keep in Touch with Former Providers

Email has enabled me to keep in touch with some of the former providers who have worked so hard with my child. One of Allison’s former providers is now professionally trained in hairdressing. Every year before Christmas this provider comes to our home to gift Allison a Christmas haircut! I love the expression, “Friends are like stars, you can’t always see them, but you know they are there.” I think of all past and present providers as being Allison’s stars, not all providers will maintain relationships with the family. The reality of employing people in your home is that some will choose, for reasons of their own, not to stay in touch with you or your child. Don’t take it personally. Life happens to everyone! Also, keep in mind that agencies may have policies forbidding contact outside of the current professional relationship.

Acknowledge Other Siblings in the Household

Shortly after putting together my first therapy team in 1997, I realized I had to address the issue of acknowledging siblings in the household. My daughter, Allison, who was receiving services in the home, was 3 years old at the time. She had a big brother, Jackson, who was 5 years old. Jackson came to think of it as normal that he would have to move from one room to another when Allison’s therapy sessions were in progress. He was always good-natured about this. I wanted to keep big brother Jackson involved with sessions, as appropriate, to help him feel more involved, instead of just frequently displaced. For example, turn-taking was a wonderful way to involve Jackson, as was the “Go Find” program.

I also reminded providers to acknowledge Allison’s brother whenever possible. I reminded them that a simple and genuine greeting will go a long way with his cooperation in the house! This helped to make Jackson’s cooperation more likely when he was asked to move to another room during a therapy session. Also, Jackson was taught to ask a provider, “What can I do to help my sister today?” when a provider started her shift. This simple act facilitated Jackson’s knowledge of his sister’s abilities, and gave him a lot of pride when he was able to tell his friends that he was helping his sister to learn! Big brother Jackson then became a big help during sessions by moving and sharing his play toys, games and puzzles and allowing space for his sister and her therapy team. Always remember, siblings are part of the household that supports the learning of the child!

Recognize That Housekeeping Is Important

Remember, your home is a provider’s work environment. I do my best to clean and tidy the therapy area before tackling any other room in the house on cleaning days. I also do a quick check of the bathroom area before sessions, as everyone appreciates a clean washroom! I make sure therapy notes, bulletins, communiqués are all neatly on their clipboards. I also make sure that my child is clean and presentable for the shift. Finally, I make sure that there is an “outing fund” with money for community activities. If my child worked towards a reward of an outing to the zoo, Dollar Store, or movie theatre, I wouldn’t want the lack of funds to delay the delivery of that reinforcer. Make sure your team knows to keep receipts for outings which are approved by the behavioral consultant and yourself. Also, remember to reimburse bus fare or gas money for a provider. Agencies will likely already have a policy in place for travel expenses as well.

Be a Good Employer, Which Means Advocating for Your Staff

Therapy time does not equate to babysitting. I had to correct a few well-intentioned neighbors who referred to my providers as babysitters. When my child is in the community, grocery shopping, at a gymnasium, or at work experience, these hardworking men and women are providing therapy, not just watching or transporting my child. Providers are important members of your child’s medically necessary treatment team. Correct misconceptions by family and friends along the way. Many family and friends may not be familiar with this type of therapy or treatment and may need some educating about the purpose and format of a home-based intervention based on applied behavior analysis. This education can help preserve the dignity and respect of your child, your team, and the discipline of applied behavior analysis for autism.

Stay in the Home During Therapy Time

For insurance purposes, many agencies require that a provider not be left alone in your home. Providers work in your home and deserve a safe and respectful environment. This means that a parent must remain in the home during a therapy session. This can be helpful for routine questions and support as well as in case of any emergencies.

Set Clear Expectations Around Cell Phone Use

The abundance of cell phones means that providers and families can be in real-time communication for shift or program issues relating to the child. However, they can also be a distraction from active treatment and supervision of my child. This has occasioned another hiring criteria for being on my child’s treatment team: Cell phone use for anything other than communication about the child, on their shift, is not acceptable. Cell phone games, texting, social media, and other social messaging are not acceptable. Even the ten seconds (as stated by one provider) it takes to text back to a friend means you are disengaged, not observing, and not “on” with your client – my child. Cell phone use expectations must be made clear from the very beginning and reiterated as needed.

Gift Giving

Holiday time was always a tough time at my home. In British Columbia, there was zero funding for autism treatment when I started my daughter’s program in 1997. I wanted to give tokens of appreciation to my daughter’s home treatment team for the holiday season. My budget was beyond tight, but homemade cards were always appreciated. One family I knew put together a cookbook of favorite home recipes for their home team; another family made a huge holiday dinner, in conjunction with a team meeting, to thank their team. There is always a way to say thank you to your team that is respectful of one’s budget.

Please note that many agencies and ethical guidelines for behavior analysts have strict policies around gift exchange and it is often not permitted. Check with your agency and your providers if you have any questions around this topic. And please do not be offended if a member of your team is not able to accept a gift.

Use Different Cultures and Celebrations as Learning Opportunities

We took the opportunity to learn about different religious holidays when one of our providers shared that she was Jewish. This was a wonderful learning opportunity for everyone on the team. We even made a card for the start of the Jewish New Year – Rosh Hashanah. Over the years, my daughter’s providers brought the wonderful gifts of sharing their religious holidays, culture, and favorite recipes that have enhanced our lives!

Making birthday cards for therapy team members gave my child the opportunity to use pencil and coloring skills, printing skills, and to sing the “Happy Birthday” song. All of these skills took a long time for acquisition. However, after all the hard work, to see my daughter use her skills to put a smile on her providers’ faces was priceless. To hear my child use her voice (she was non-verbal for the first 6 years of her life), and to hear her sing Happy Birthday – well, it is a win-win situation!

With a therapy team, it is a wonderful opportunity to have a simple celebration for each of the several birthdays throughout the year. My child learned that birthdays are for others as well as for herself. This learning extended to teaching big brother Jackson that every time we celebrate a birthday, he does not always get a present!

As our programs progressed, our behavior consultant added a cooking and baking program to help include both children in all household birthday celebrations for family members and members of the treatment team. The beauty of a cooking program was that skills, such as: counting, measuring, mixing, pouring, baking, decorating with icing, and washing and putting away dishes, were all “taught” in a fun way. This was a very detailed program with the huge reinforcer of getting a tasty item to eat at the end of completing a recipe!

In Summary

Managing an ABA treatment team in your home can be challenging but can be rewarding as well. There are many things you can do to help the team work well together and be effective in providing your child with the services he or she needs and deserves. Remember, it’s a learning process for all!

Please use the following format to cite this article:

Sharpe, B. (2017). Clinical corner: Managing a home-based ABA program. Science in Autism Treatment, 14(3), 17-20.

About The Author 

Beverley Sharpe is a founding member and Director of Families for Early Autism Treatment of B.C. (FEATBC). Bev’s daughter Allison was diagnosed with autism twenty years ago and Bev became an advocate for effective autism treatment. She was a member of the Legal Steering committee for the Canadian landmark decisions (Auton and Hewko) regarding autism treatment. Bev participates in new parent intake, political lobbying, fundraising, and speaks regularly with parents regarding advocacy in the school system. She also helps new parents access funding for autism treatment.