Applied Behavior Analysis (ABA) Therapy in Schools for School Administrators and School Staff Part 1

Vanessa Tucker Author

03/22/2024 Added

110 Plays

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[00:00:07.950]My name is Dr. Vanessa Tucker.
[00:00:09.780]I am from Washington State, so it's 1:30 right now.
[00:00:15.030]And I know the rest of you maybe are
[00:00:16.620]at the end of your workday,
[00:00:17.790]so thank you for taking out some time to come
[00:00:21.240]and talk about these very important issues.
[00:00:23.790]This is part one of two.
[00:00:25.860]So if you are signed up for this session,
[00:00:29.490]next week, we're going to get more into the application
[00:00:32.790]of these concepts.
[00:00:33.690]So I'm delighted to be able to talk to you about this.
[00:00:36.690]I will say I've now been
[00:00:38.850]in the field for 29 years,
[00:00:42.060]and I have been a BCBA for 12.
[00:00:46.860]So I think I need to update my bio somewhere in there.
[00:00:50.880]But thank you so much for the warm welcome.
[00:00:54.420]And let me just start by saying that if you are here,
[00:00:59.100]you're interested in applied behavior analysis,
[00:01:01.650]either because you're a school administrator,
[00:01:04.950]or maybe you work for a district as a teacher
[00:01:07.770]or a related service provider,
[00:01:10.320]or maybe you are a BCBA,
[00:01:13.380]and you're looking for more information about perhaps how
[00:01:16.740]to educate others about what you do.
[00:01:19.650]For this hour, we're really going to dive into that
[00:01:22.497]and some of the issues that come
[00:01:25.080]with the discussion of services,
[00:01:27.540]especially in light of how they are being utilized
[00:01:30.990]in the school setting.
[00:01:32.460]So I will go ahead and go to the next slide.
[00:01:37.770]And I like to teach from a scenario-based perspective.
[00:01:41.340]So this week and next week and then the other two
[00:01:44.610]that are more focused
[00:01:45.570]for BCBAs will have a lot of scenarios.
[00:01:48.090]So I don't normally read PowerPoints.
[00:01:50.353]I will read one today, though. I wanna read these.
[00:01:53.040]So a special education program provides services
[00:01:55.980]for students with autism spectrum disorders
[00:01:58.560]and other like disabilities.
[00:02:00.750]A parent of a child with autism spectrum disorder demands
[00:02:03.930]that their BCBA and RBT provide services
[00:02:07.230]in the school setting because "they have the skills,
[00:02:10.050]and it is medically necessary."
[00:02:12.750]The parent states the special education program
[00:02:15.060]is not designed to provide ABA services
[00:02:18.300]and that their child has a right to receive them.
[00:02:21.180]The parent wants all day supports
[00:02:23.070]or wants the district to pay for the child
[00:02:25.440]to receive services in a full day clinic program.
[00:02:29.340]I am going to tell you that this happens,
[00:02:33.510]and it happens often, especially in Washington State.
[00:02:37.560]And there's a lot to unpack around this scenario
[00:02:41.100]that I've included here.
[00:02:42.810]I will try to unpack the majority of the things
[00:02:46.890]that are embedded with this scenario,
[00:02:48.870]and you may say, "Gosh, I'm dealing with this right now.
[00:02:52.830]What do I do about that?"
[00:02:54.450]So let's talk a little bit about maybe some things
[00:02:57.690]that are related to the scenario,
[00:02:59.880]starting with just exploring what it is
[00:03:02.970]that we're talking about.
[00:03:08.351]So I am also a certified special ed and general ed teacher
[00:03:12.000]and have been since 1995.
[00:03:15.060]I can remember that time when I first met a BCBA,
[00:03:21.630]and I had no idea what that was.
[00:03:25.320]I didn't know anything about the profession,
[00:03:28.770]and it was an experience I will never forget.
[00:03:32.400]This person, who was really nice, was a mystery to me.
[00:03:37.020]She was brought in for a student that I worked with
[00:03:43.170]who was very severe and complex in her disability.
[00:03:47.010]And she came in and designed this program
[00:03:52.410]that I could not figure out.
[00:03:55.290]I had no idea what she was doing.
[00:03:57.330]And the parents basically said,
[00:03:58.597]"You have to provide this service. You have to do this."
[00:04:02.430]And the district didn't know how to handle it.
[00:04:05.400]And so they really just said,
[00:04:07.267]"Well, just sort of figure it out, Vanessa."
[00:04:10.080]So I did.
[00:04:16.830]My first blush impression of her was,
[00:04:19.980]okay, she's like, super para.
[00:04:24.270]She's able to do things with this student.
[00:04:26.070]She was able to get the student to do things
[00:04:28.260]that I didn't know she could do.
[00:04:31.050]The field of ABA really hadn't become very familiar
[00:04:34.380]to schools yet, by the way.
[00:04:36.000]So this was probably,
[00:04:38.370]well, gosh, this is at least 20 years ago.
[00:04:41.880]So she designed this program with this big program book.
[00:04:45.480]And in that program book were all these things
[00:04:47.670]that paraeducators were supposed to do
[00:04:50.460]with the student all day long.
[00:04:52.500]And the parents said,
[00:04:54.037]"Okay, we're gonna have things going on.
[00:04:57.690]We're gonna have these programs.
[00:04:59.040]That's what she's going to do all day long
[00:05:00.660]and that's what school's going to be."
[00:05:02.580]But what I noticed was instead
[00:05:06.210]of what was potentially out in the school for her
[00:05:10.470]to access, like peers or going to the gen ed classroom
[00:05:14.400]or going to an assembly,
[00:05:17.280]that the goal for the family was to have her worked
[00:05:20.400]through these programs all day long.
[00:05:23.220]So my first question as a teacher was,
[00:05:27.240]is this something special
[00:05:28.740]or different that I've never heard of before?
[00:05:31.800]And that kind of was what initially led me down this path
[00:05:36.180]of discovering, all right, what is ABA in schools
[00:05:39.390]and even to getting my own board certification.
[00:05:42.720]So the first question
[00:05:43.860]that I think we need to talk about as a profession:
[00:05:47.340]Is ABA something special or different?
[00:05:51.330]And that is part of a larger question of,
[00:05:54.570]what is going on here?
[00:05:57.000]When we have parents, for example,
[00:05:59.790]bring in providers who come in with their program book,
[00:06:03.150]and I'm sure some of you are very familiar
[00:06:05.400]with that terminology when I say they bring
[00:06:07.890]in their program book and they're doing something,
[00:06:09.630]but we're really not sure what is that,
[00:06:12.600]sometimes the impression that families have,
[00:06:16.740]or even professionals like myself might believe
[00:06:22.140]that ABA is something so radically different
[00:06:24.690]that it isn't possible to employ these strategies
[00:06:30.030]in a school.
[00:06:31.260]So I would offer this as a way to frame the conversation.
[00:06:38.040]Looking at these approaches here,
[00:06:40.860]we have this list.
[00:06:42.510]And I'd like you to think for a minute
[00:06:44.880]about what all of these things have in common.
[00:06:48.540]So these are approaches that are very common
[00:06:51.570]to see in a school setting,
[00:06:55.170]in a school that's using PBIS or MTSS.
[00:07:01.290]So what do you think? You can write it in the chat box.
[00:07:03.960]What do they have in common?
[00:07:11.520]And I'll just start looking at your answers.
[00:07:14.790]This is not a trick question.
[00:07:21.930]Okay, someone said they're evidence based.
[00:07:26.040]Evidence-based practices,
[00:07:27.600]designed to increase or decrease a behavior,
[00:07:31.290]token systems, motivators,
[00:07:38.010]good teaching based on ABA.
[00:07:40.440]Okay, so Stewart got it first, I think.
[00:07:45.600]The idea here is that all of these strategies
[00:07:49.860]that are commonly used in schools have their foundations
[00:07:54.000]in applied behavior analysis.
[00:07:57.030]And what you need to know is
[00:08:00.330]that it took me quite a while to figure out that,
[00:08:04.740]all right, ABA, maybe it's not something that's so different
[00:08:08.850]that it's exclusively outside of what we already do.
[00:08:12.180]That as I've learned more
[00:08:13.800]and as you've implemented these things,
[00:08:15.660]we need to remember
[00:08:17.610]that we're already applying the principles
[00:08:20.730]of applied behavior analysis in the school setting.
[00:08:24.150]These practices here are very common,
[00:08:28.350]especially out where you are.
[00:08:29.880]So I know that in Nebraska, Colorado, Kansas,
[00:08:34.770]these are something that are baked
[00:08:36.810]into what you do every day
[00:08:39.060]as special educators and general educators.
[00:08:43.050]So if I want to then answer the question,
[00:08:47.479]is there something so special or different about ABA,
[00:08:50.310]I would have to say, well, not really,
[00:08:51.990]because it's a scientific practice
[00:08:54.750]that is applied to learning.
[00:08:56.820]So all the things that you said are true.
[00:08:59.580]These things are evidence based.
[00:09:01.500]They are designed to motivate. They're good teaching.
[00:09:05.700]They're also founded on principles
[00:09:07.800]of applied behavior analysis.
[00:09:09.900]So one of the things that we get asked a lot,
[00:09:13.710]we, I'm guessing probably everyone in this room, is,
[00:09:19.020]does ABA already exist in the school setting?
[00:09:22.410]And from this list alone, we would be able to say yes.
[00:09:26.010]The things that we are doing here,
[00:09:28.830]assess, teach, break down,
[00:09:32.100]and systematically structured teach behaviors, right,
[00:09:36.330]so we have systematic interventions and reinforcement here,
[00:09:40.620]that's all part of what ABA is.
[00:09:43.800]So with that in mind, let's talk about what ABA is,
[00:09:48.540]because the intent here is not to say
[00:09:52.200]that ABA doesn't have its place.
[00:09:55.320]The intent is to help us as an educational community
[00:09:59.550]to have an answer to, where does ABA fit?
[00:10:02.700]Are we already doing ABA?
[00:10:04.800]And what is so different about outside services?
[00:10:07.830]So one of the things that I want to make sure
[00:10:11.280]that people understand, as a behavior analyst,
[00:10:14.610]is that applied behavior analysis, or ABA,
[00:10:17.900]is a science of learning, and it is applied
[00:10:21.510]to what we call socially significant problems and behavior.
[00:10:24.890]In other words, the application of what we do is designed
[00:10:31.080]to make a difference in someone's life.
[00:10:33.720]And that could be something like learning
[00:10:35.550]how to brush your teeth, or learning how to ride a bus,
[00:10:40.260]or learning how to engage
[00:10:43.020]in a conversation with someone else,
[00:10:45.540]or how to safely regulate your body
[00:10:48.930]so that you don't hurt yourself.
[00:10:51.210]So ABA as a field is a science,
[00:10:55.260]and it's a science of learning and shaping behavior.
[00:10:58.530]And it really is specific to those things
[00:11:00.420]that we call socially significant.
[00:11:02.760]It's a discipline,
[00:11:04.320]and like every other discipline
[00:11:06.450]that is represented within school, it's based on data.
[00:11:10.470]So we can't as BCBAs claim
[00:11:13.680]that we are the only related service providers
[00:11:18.030]in the world that treasure our data.
[00:11:20.040]But we do treasure our data, for sure.
[00:11:22.650]And that data helps us
[00:11:24.210]to analyze what exactly is happening.
[00:11:28.710]So whether or not what we're doing
[00:11:31.380]is making a meaningful behavior change.
[00:11:34.230]We also highly prize our ethics.
[00:11:36.360]And again, we're not the only field that does that.
[00:11:39.000]And one of the things
[00:11:39.900]that I'm always telling my ABA students
[00:11:43.470]who are getting credentialed is ethics is
[00:11:47.790]of primary importance in our field,
[00:11:49.920]but we're not the only ones that feel that way.
[00:11:52.050]So we have to know it's not something that's special
[00:11:54.210]and unique just to BCBAs.
[00:11:56.910]And again, as I showed you in a couple of slides back,
[00:12:02.250]these principles are foundational to the things
[00:12:04.800]that you do all the time
[00:12:07.140]in order to teach and reinforce behavior,
[00:12:10.200]or even teach and reinforce reading
[00:12:12.120]or any other academic subject.
[00:12:14.580]So there's no mystery here.
[00:12:17.280]There's nothing here other than it is a science.
[00:12:21.510]And it has a rigorous research base.
[00:12:24.480]So we can say with confidence that the strategies
[00:12:29.010]that we use produce meaningful behavior change
[00:12:32.100]that's socially significant.
[00:12:33.390]That is true.
[00:12:34.830]So let's talk a little bit about what ABA is not,
[00:12:39.240]because I think that's just as important for us in the room
[00:12:43.200]as we think about how to navigate these situations
[00:12:46.260]where we're getting asked, you know,
[00:12:48.600]could ABA come into the school?
[00:12:50.370]And what would that mean? And how would that look?
[00:12:54.000]So the first thing I would say is an ABA
[00:12:56.370]is not a person delivering services, okay?
[00:12:59.250]So I hear, and I think it's kind of funny when someone says,
[00:13:02.017]"Well, an ABA is coming into the classroom."
[00:13:04.320]And I have to say, "Well, all right,
[00:13:06.990]maybe a BCBA is coming into the classroom.
[00:13:09.750]A registered behavior technician is coming in."
[00:13:12.210]An ABA is not a person.
[00:13:14.550]So a person delivering services could very well be
[00:13:19.170]the implementer of the science, but that's not what ABA is.
[00:13:23.280]And the next thing I would say is
[00:13:25.140]that ABA is not a curriculum in a box.
[00:13:27.480]So it has struck me as interesting over the years
[00:13:31.650]that all these curricula have come out.
[00:13:34.230]And I won't name them, but I'm sure you know.
[00:13:36.870]It's a short list where the idea is
[00:13:40.170]that if you just teach this from this curriculum,
[00:13:43.980]you are doing ABA.
[00:13:46.230]And I will say that there are aspects of the curricula
[00:13:50.670]that are marketed and that are out there
[00:13:52.530]that are very important.
[00:13:53.790]And there are aspects of the curricula
[00:13:55.530]that provide good assessment, good data collection tools,
[00:13:59.880]but that does not guarantee
[00:14:01.710]that a person is benefiting from true application
[00:14:06.090]of these principles and procedures.
[00:14:08.970]The next thing that you need to remember
[00:14:11.130]is that ABA is not something
[00:14:12.780]that is solely provided in the clinic.
[00:14:15.090]I remember very clearly as a young teacher sitting
[00:14:20.100]in an IEP meeting with a family
[00:14:22.320]that also had outside providers.
[00:14:25.500]They had an outside BCBA and speech.
[00:14:28.860]And we were sitting around a table
[00:14:30.990]and our school-based BCBA,
[00:14:34.320]not BCBA, excuse me, SLP was there.
[00:14:37.170]And the parents said, "Well, you know, he,
[00:14:41.250]the student, is only getting real speech on the outside."
[00:14:45.720]He's not getting speech in school.
[00:14:48.600]And the SLP next to me said, "Well, I'm an SLP."
[00:14:53.250]And the parents said, "Yes,
[00:14:54.300]but the outside people are different.
[00:14:57.900]They're trained differently than you."
[00:15:00.120]And to which the SLP said,
[00:15:01.867]"Well, no, actually, that's not true.
[00:15:04.320]The difference is the scope."
[00:15:06.840]So in a clinical setting,
[00:15:10.320]a provider like an SLP
[00:15:12.840]or an OT has a scope of practice
[00:15:16.440]that's much larger than what is allowed
[00:15:19.530]in a school setting.
[00:15:20.430]So the scope of practice
[00:15:22.800]in a school setting might be this narrow,
[00:15:25.230]whereas in a clinical setting,
[00:15:27.450]the scope of practice is a lot wider.
[00:15:30.360]It does not mean that there's a difference
[00:15:32.580]in training or competence.
[00:15:35.100]It's what is allowable in that setting.
[00:15:38.070]So we, again, I think we all need to think about this,
[00:15:40.800]that applied behavior analysis is not something
[00:15:44.430]that is clinic specific.
[00:15:47.010]There also been this discussion
[00:15:50.250]about medical versus educational applied behavior analysis.
[00:15:54.420]And I don't know about you,
[00:15:56.070]but it really surprised me when it first came up.
[00:15:58.890]And the only thing that I can figure out
[00:16:00.990]is that medical ABA, as it is termed,
[00:16:04.950]is provided by an insurance company.
[00:16:07.200]So it has a prescription attached to it,
[00:16:10.500]it has a prior authorization attached to it,
[00:16:13.530]and it is done
[00:16:15.420]because the prescribing provider has said
[00:16:19.590]that this is medically necessary for this person
[00:16:22.530]to work on and develop socially significant behaviors.
[00:16:27.870]Now, medically necessary ABA
[00:16:31.650]and medical ABA are two different things.
[00:16:34.170]So it may very well be medically necessary
[00:16:36.870]because the provider has said it's based on this diagnosis.
[00:16:40.470]But medical ABA medical in its truest sense
[00:16:45.390]is applied behavior analysis that is supportive
[00:16:49.140]of accessing, for example, the CAT scan in the hospital,
[00:16:55.440]or learning how to give yourself shots if you're a diabetic.
[00:17:01.380]So in that term,
[00:17:03.660]it needs to be carefully scrutinized.
[00:17:06.300]Educational ABA, on the other hand,
[00:17:09.330]gets put side by side as though somehow they're different.
[00:17:12.750]But when you think about it, the strategies are the same.
[00:17:16.950]We apply reinforcement to behaviors
[00:17:21.330]that are based on function.
[00:17:23.190]We manipulate antecedents in order to change behavior
[00:17:27.930]or make it unnecessary.
[00:17:29.640]So I think that we need to be very clear
[00:17:34.440]when that terminology is floated to us
[00:17:37.620]that it is applied behavior analysis as a science,
[00:17:43.110]not medical versus educational.
[00:17:46.230]And if it is being thrown out that way,
[00:17:48.000]it's most likely paired with insurance funded
[00:17:50.790]versus something that's provided in school.
[00:17:54.150]ABA is not something that is better
[00:17:56.250]if delivered by an outside person.
[00:17:58.620]So I think there is this perception that somehow,
[00:18:02.310]outside is better.
[00:18:03.750]And I want to unpack that in our short time together today
[00:18:08.010]and next week.
[00:18:09.570]The idea here is what is socially significant,
[00:18:13.260]and in what context?
[00:18:14.640]And that is something that we'll discuss a little bit later.
[00:18:17.940]It is not separate from the provision
[00:18:21.060]of evidence-based practice that we design and deliver
[00:18:25.650]in the school setting setting.
[00:18:27.090]So the idea here that's often put out is,
[00:18:31.380]well, the school practices are not
[00:18:35.160]based on applied behavior analysis.
[00:18:37.140]And we can look at that list
[00:18:38.820]that I showed you a few slides ago
[00:18:40.410]and say that's simply not the case.
[00:18:42.630]That what we are doing and have been doing are
[00:18:46.170]based on the foundation of the science.
[00:18:49.830]And then ABA is never a replacement
[00:18:53.010]for high-quality schooling.
[00:18:54.870]So I'll come from the position that school
[00:18:56.820]is the normalized natural environment for every student,
[00:19:01.260]with very few exceptions.
[00:19:02.970]And when we think about IDEA,
[00:19:05.970]we have to consider what that continuum is.
[00:19:08.820]But it should never be a substitute in full
[00:19:12.090]for accessing school.
[00:19:14.310]So with that in mind,
[00:19:15.810]let's continue and talk about just what are BCBAs
[00:19:21.060]and what do they do.
[00:19:24.090]So we'll start there.
[00:19:25.320]And I have the magic wand there for a reason.
[00:19:27.420]I'll talk about that in a minute.
[00:19:29.490]When you hear terminology out there in field,
[00:19:33.510]you might hear someone say a BCBA.
[00:19:36.540]BCBA is a board certified behavior analyst
[00:19:40.830]that has gone to school, has at least a master's degree
[00:19:44.670]or is a psychologist, and who has passed a clinical exam,
[00:19:50.610]so a board exam, and has the right number of hours
[00:19:54.390]to have passed.
[00:19:55.470]A BCaBA is a board certified assistant behavior analyst.
[00:20:00.720]They have lesser numbers of hours that they have to meet,
[00:20:05.550]and they have a bachelor's degree
[00:20:07.500]instead of a master's degree.
[00:20:09.600]A registered behavior technician
[00:20:11.670]is a step below the BCBA
[00:20:16.327]and BCaBA in the sense that they are someone
[00:20:19.260]who you could think is tantamount to a paraprofessional.
[00:20:23.130]In other words, they are the ones doing the majority
[00:20:25.710]of the work.
[00:20:26.790]They are the ones that act under the supervision
[00:20:30.030]of the BCaBA or the BCBA.
[00:20:33.990]And so it's not too much different, if you think about it,
[00:20:37.140]from a teacher and a paraprofessional
[00:20:40.680]or a related service provider.
[00:20:43.110]Like, in the State of Washington,
[00:20:44.550]we have the speech language pathologist,
[00:20:46.830]and then we might have an SLPA,
[00:20:49.110]so a speech language pathologist assistant,
[00:20:52.230]who operates under their license.
[00:20:54.930]And then you'll see that states differ in the way
[00:20:58.170]that their licensure is defined and titled.
[00:21:01.830]So most states now,
[00:21:04.590]people like me are able to bill for insurance
[00:21:09.390]because we have a medical license.
[00:21:11.430]We may also work in schools,
[00:21:13.800]but we are able to work in a medical capacity
[00:21:20.100]and bill insurance solely or work in the school setting.
[00:21:24.210]And some people may even be called related service providers
[00:21:28.620]depending on the state and the way
[00:21:30.810]that the district words that.
[00:21:33.270]So the other thing to know is that there are some people
[00:21:38.070]who are also certified teachers
[00:21:41.010]or might be a speech language pathologist and a BCBA.
[00:21:46.080]So some people have dual certification,
[00:21:49.830]which in my mind is great
[00:21:51.750]because we are able to see things from multiple angles.
[00:21:56.040]And that becomes a very important gift
[00:21:59.010]when it comes to talking about how do these things relate
[00:22:01.800]in school or clinical life, vice versa.
[00:22:05.970]What I want people to know is
[00:22:07.920]that there's this perception out there
[00:22:10.260]that somehow the BCBA is going to come in
[00:22:13.830]and have all of the answers.
[00:22:16.170]And I will tell you that that's simply is not true.
[00:22:19.050]There is no magic wand.
[00:22:20.400]And I often wish that I had one
[00:22:23.190]because usually when I get called out to something,
[00:22:26.490]it's never good.
[00:22:28.050]It's normally something that has gone very wrong,
[00:22:31.920]and people are wanting us to fix everything.
[00:22:36.690]We have our skillset, like every other discipline does,
[00:22:41.010]and ultimately our job should be to collaborate
[00:22:44.610]with everybody else in order to solve these problems.
[00:22:48.690]So a BCBA in your scenario could be
[00:22:52.890]a lot of different things.
[00:22:54.060]If you're working in a district
[00:22:55.800]and you have someone,
[00:22:57.300]let's say, for example, they're a teacher
[00:22:59.190]and they have their BCBA,
[00:23:01.890]then they are able to employ both skillsets.
[00:23:06.810]All right.
[00:23:08.700]At any time, by the way, if you have questions,
[00:23:10.830]you can put them in the Q&A,
[00:23:12.660]or you can put them in the chat.
[00:23:15.060]Every time I see a chat,
[00:23:16.620]I'm looking just so I can kind of monitor.
[00:23:19.230]What I wanna do now is I wanna move to the roles.
[00:23:22.650]And this is going to set us up
[00:23:25.320]for the rest of this session and next week's as well.
[00:23:30.230]So what are the roles of BCBAs in various settings?
[00:23:35.160]I think one of the most important things
[00:23:36.930]that we can do is look at the differences
[00:23:41.160]between a BCBA and how they might work in a school setting
[00:23:45.990]and a BCBA working in a clinic.
[00:23:48.540]And this is sort of like pulling the curtain back,
[00:23:50.970]because many people don't realize the duties
[00:23:55.800]or the things that are happening
[00:23:58.260]with clinically based BCBAs.
[00:24:01.230]But I wanna start with school
[00:24:02.880]because that really is what we are focusing on today,
[00:24:06.690]is school.
[00:24:08.370]And next week as well.
[00:24:09.990]So the school-based BCBA is often someone
[00:24:14.100]who is contracted or hired by the school district.
[00:24:19.740]And their role truly is
[00:24:22.710]to support other people who are the cert in charge.
[00:24:26.550]So if you've heard of that term,
[00:24:28.920]what I'm referring to is a certificated person
[00:24:32.340]who is in charge of the IEPs,
[00:24:36.150]the students, the paraprofessionals.
[00:24:39.420]And the BCBA's job primarily is to support others.
[00:24:43.410]So whether they're supporting the teacher
[00:24:45.240]or supporting the occupational therapist
[00:24:47.880]or supporting the PE teacher, their role is to do that.
[00:24:52.290]They are an IEP team member.
[00:24:55.230]And that could look like a behavior specialist.
[00:24:58.620]That could look like an actual related service provider.
[00:25:03.510]Can look like many different things,
[00:25:05.040]and it should look like many different things,
[00:25:06.990]depending on the context.
[00:25:08.880]They're also likely to be an evaluation team member.
[00:25:13.410]So when we suspect or we know that behavior
[00:25:17.340]is adversely impacting a student's access,
[00:25:21.090]having a BCBA on the team can be a very good thing to do.
[00:25:25.590]So when we're talking about behavior specialist,
[00:25:28.470]I wanna clarify two terms.
[00:25:31.080]First of all,
[00:25:31.913]behavior specialist can be interpreted pretty broadly
[00:25:35.730]depending on where you are.
[00:25:37.980]So that could be someone that goes in
[00:25:40.800]and provides tier one services to a classroom
[00:25:45.690]or a grade level that is struggling
[00:25:47.940]with those low-level behaviors
[00:25:50.340]that are exacerbating everything else.
[00:25:52.650]They could do that.
[00:25:54.150]They might be someone who comes out
[00:25:56.250]to work on tier two cases
[00:25:58.350]where we need to provide a rapid response,
[00:26:01.680]a higher dose of whatever it is that we're doing.
[00:26:05.520]Maybe we are doing a functional behavior assessment
[00:26:09.480]or working with a small group.
[00:26:11.760]Or it could be that that person is working
[00:26:14.910]with a child who is tier three
[00:26:17.700]or already qualified for special education
[00:26:20.880]and whose behaviors have gone to a level
[00:26:23.550]where that kind of support is needed.
[00:26:25.620]Behavior specialists can do a wide variety of things.
[00:26:29.370]Now, a related service provider is somebody
[00:26:32.460]who would be providing services
[00:26:34.470]in support of special education.
[00:26:37.110]And that might mean that a BCBA is actually
[00:26:40.950]on the IEP matrix.
[00:26:42.780]Doesn't that goals are written,
[00:26:44.370]but they may have minutes on the IEP
[00:26:48.270]in which they're supporting that student
[00:26:50.640]with whatever it is that they need behaviorally.
[00:26:53.490]And again, they would be considered a provider
[00:26:56.430]of whatever tiered interventions are necessary.
[00:27:00.270]Now, many times BCBAs are asked to draft FBAs
[00:27:06.390]and positive behavior intervention plans.
[00:27:08.460]What I find really interesting
[00:27:09.930]is that this varies district to district and state to state.
[00:27:14.372]And I'm sure within our group here,
[00:27:16.860]you know of districts who say,
[00:27:19.597]"Only the school psychologists write the FBAs
[00:27:23.130]and behavior plans."
[00:27:24.150]And then others say, "Well, the whole team writes them."
[00:27:28.590]Or some will say, "Just the BCBA writes them."
[00:27:32.820]So we'll start there.
[00:27:35.340]And then, in my opinion,
[00:27:37.590]best practice is this needs to be a team effort
[00:27:40.800]with all voices at the table.
[00:27:42.840]So parent voice, teacher voice, administrator voice,
[00:27:48.300]every voice at the table.
[00:27:50.700]And we as behavior analysts would come in
[00:27:54.450]if our skills were needed
[00:27:56.070]because of the severity of the behavior.
[00:27:58.050]We are not the sole owners of the skills
[00:28:00.390]on how to develop them,
[00:28:03.180]is, I guess, one other thing I would say.
[00:28:05.970]However, a really good use of our services
[00:28:08.580]is to model and reinforce skills, whatever they are,
[00:28:12.360]such as the design and the collection/analysis of data.
[00:28:17.370]That is something that I think we can bring,
[00:28:20.910]we meaning behavior analysts, to the table.
[00:28:23.460]That can be very, very helpful for school teams.
[00:28:27.150]We also might provide supervision for behavior technicians.
[00:28:31.770]So you'll notice that I put BTs here instead of RBTs.
[00:28:37.440]So depending on where a behavior technician practices,
[00:28:41.370]they may need to be licensed or not licensed.
[00:28:45.240]And a lot of that has to do with insurance.
[00:28:47.580]So if we get rid of that, the behavior technician,
[00:28:51.060]if they have that certification
[00:28:53.970]through our national licensure,
[00:28:55.890]has to be supervised for a minimum amount
[00:28:58.920]of time every month by the BCBA.
[00:29:02.640]So the BCBA would be doing that.
[00:29:05.460]And then, also, the BCBA could be a collaborator,
[00:29:09.090]somebody that's bringing people together,
[00:29:11.820]families, teachers, and other providers.
[00:29:14.670]And again, we basically are there to support a student
[00:29:18.930]to access special and general education with their behavior.
[00:29:23.010]So there's a lot going on with that.
[00:29:24.990]And I want to then compare that
[00:29:26.730]to what is happening in a clinic-based situation.
[00:29:30.270]So in a clinic-based situation,
[00:29:32.730]it's a very different model and expectation.
[00:29:37.050]The clinic-based BCBA is the head of the case.
[00:29:40.680]So if a BCBA has 6 cases or 12 cases,
[00:29:45.960]they are the person that is in charge of those cases.
[00:29:49.950]And, in most cases, insurance is the driver.
[00:29:54.570]Whereas in the school setting,
[00:29:56.430]the IEP and the evaluation are the driver.
[00:29:59.760]So in the clinic, insurance is.
[00:30:02.130]So the frequency of treatment plans,
[00:30:05.640]the content of the treatment plans,
[00:30:08.850]the type of goals we can work on are
[00:30:12.330]in large part dictated by what the insurance company
[00:30:15.660]is saying that they want and they require.
[00:30:18.630]The BCBA provides assessments,
[00:30:21.390]they provide the treatment plans,
[00:30:23.850]and they write all of the programming that needs
[00:30:27.720]to be done with the student.
[00:30:30.060]They supervise that registered behavior technician
[00:30:33.390]or technicians.
[00:30:34.410]Sometimes there's more than one on a case.
[00:30:37.230]They design everything,
[00:30:39.210]delegate, train, and monitor everything.
[00:30:42.240]And as part of these services,
[00:30:44.220]they provide parent training to the family.
[00:30:47.970]They may also need to push into other environments.
[00:30:52.050]So in the work that I do,
[00:30:54.210]sometimes I'm pushing into a hospital setting
[00:30:56.580]or into a group home setting or even to a school setting.
[00:31:00.540]So you can see the difference here
[00:31:02.310]in terms of who the BCBA even needs to answer to.
[00:31:07.260]In the clinical setting,
[00:31:09.150]the variables are very tightly controlled
[00:31:11.910]around the BCBA is the head of this,
[00:31:13.920]but in the school, that's not the case.
[00:31:16.260]And that makes for an interesting dilemma,
[00:31:18.300]especially if a BCBA from a clinical setting is coming in
[00:31:21.960]and trying to understand this environment called school.
[00:31:27.150]So I wanna talk about that next. The contexts are different.
[00:31:31.380]Now, those of you that are administrators
[00:31:33.600]or teachers in the room,
[00:31:34.860]as you work with BCBAs maybe that have been hired
[00:31:39.330]or that are coming in,
[00:31:41.310]they're going to have a different lens
[00:31:44.070]of how they experience this depending on
[00:31:47.160]what they've already seen.
[00:31:48.900]So in school, what do we know?
[00:31:50.850]The group size can be totally different.
[00:31:53.070]So it could be that the student is in a small classroom
[00:31:57.330]or in a regular classroom,
[00:31:59.310]or is in many different settings,
[00:32:01.260]like transitioned from one place to another
[00:32:03.570]or recess or whatever it is.
[00:32:06.000]And there are so many variables.
[00:32:08.640]This is what I like about school.
[00:32:09.840]The noise, other students, all the activities,
[00:32:12.570]and things that there are to do and see.
[00:32:15.210]The other thing that's really different about school
[00:32:18.060]that BCBAs need to know when they come in
[00:32:21.090]is that they are not in charge.
[00:32:22.950]The teacher is in charge.
[00:32:24.930]And that certain charge mentality needs to be something
[00:32:28.590]that is acquired as a value right away.
[00:32:32.400]In other words, if I were to come in,
[00:32:34.290]I need to be respectful that this is not my classroom.
[00:32:37.650]That is that teacher's classroom.
[00:32:39.660]They are the ones that are case managing these IEPs
[00:32:42.960]and that are supervising all the professional people
[00:32:47.880]that are in that environment
[00:32:49.860]and working with other members of the IEP team.
[00:32:52.650]So that context is something that people
[00:32:55.620]who work in schools understand and understand pretty deeply.
[00:32:59.190]And then there's the clinic.
[00:33:00.570]The clinic is something completely different.
[00:33:03.420]It's individualized.
[00:33:05.040]Sometimes you get small groups.
[00:33:07.320]That is actually pretty rare.
[00:33:08.910]So for the most part,
[00:33:10.080]I tend to see a one-on-one situation,
[00:33:13.710]child is sitting with the RBT or the BCBA, or both,
[00:33:18.300]and the variables are tightly controlled.
[00:33:20.670]What do I mean by that? There is not noise.
[00:33:23.640]There are only certain items in the room.
[00:33:26.040]Task demand is different.
[00:33:27.750]So there's no teacher, there's no academic demands.
[00:33:31.200]And I will say,
[00:33:32.160]and this is something that is both a blessing and a curse,
[00:33:35.670]is that parents are maximally involved.
[00:33:37.530]Let me tell you why.
[00:33:38.490]It's because parents who are involved in these quickly learn
[00:33:44.160]that their input is valued,
[00:33:47.700]that their contact with the team is frequent.
[00:33:52.020]And that is something
[00:33:53.250]that is a very good part of these programs.
[00:33:56.460]May not necessarily be something we can replicate
[00:34:00.090]at all times in a school setting.
[00:34:02.580]So we'll talk more about that soon.
[00:34:04.920]There is a high level of communication
[00:34:08.880]in a clinic-based program with the family
[00:34:11.730]because in truth, all the other variables have been removed.
[00:34:15.690]It's the BCBA, the BT, and the family.
[00:34:18.690]And the family has access to a large amount
[00:34:21.600]of data in real time that is graphically displayed.
[00:34:24.840]Ultimately, the BCBA is in charge,
[00:34:27.300]and the supervision is done by the BCBA.
[00:34:30.930]So you can see how, depending on whether
[00:34:33.930]or not these two entities are familiar with each other,
[00:34:37.860]there can be a lot of misunderstanding.
[00:34:41.790]In truth, that's exactly what we're trying to do,
[00:34:44.130]is to build that understanding.
[00:34:46.560]I will say that each has the strengths
[00:34:49.710]that we need to talk about that they bring, and advantages.
[00:34:52.860]So again, you heard me say earlier,
[00:34:56.130]school is a natural environment for students.
[00:34:59.250]That, to me, is something that we need to hold
[00:35:02.460]as a treasured part of the conversation.
[00:35:06.390]School is a natural environment for kids. And what is there?
[00:35:10.350]Well, there are peers there.
[00:35:12.570]Typically developing ones or peers in general.
[00:35:15.690]And that is not something
[00:35:17.280]that we can replicate necessarily in a clinical setting.
[00:35:21.780]We have evidence-based interventions that are tiered.
[00:35:25.890]And that's not to say that those things might not be
[00:35:29.130]available in the clinic, but what is missing is instruction
[00:35:33.570]and academic and social skills
[00:35:36.030]that cannot be replicated in a clinic environment.
[00:35:39.390]A classroom-type environment is normalized.
[00:35:43.560]In other words, everyone is expected to be in school.
[00:35:46.590]School is your job between the ages of kindergarten
[00:35:49.590]and when you turn 18.
[00:35:51.780]And this is an environment
[00:35:53.520]in which you learn those expected skills
[00:35:55.890]that later should generalize to things like
[00:35:59.310]in the work environment, or living with other people,
[00:36:02.430]or learning around other people in the post-secondary life.
[00:36:07.320]Also, school has another important advantage,
[00:36:10.320]and that is access to teachers
[00:36:11.940]and related service providers.
[00:36:13.530]Very difficult to replicate that in a clinic setting.
[00:36:16.950]So let's move to the clinic.
[00:36:18.180]What strengths and advantages does it bring?
[00:36:21.930]Well, there's some students that need less distractions.
[00:36:26.100]The school environment in general
[00:36:28.710]is not built necessarily for the learning preferences
[00:36:33.900]or strengths of people with autism.
[00:36:36.060]It can be loud. It can create sensory overload.
[00:36:40.440]It can be very difficult to concentrate
[00:36:43.020]and to benefit from that environment,
[00:36:46.050]unless we have set it up correctly,
[00:36:48.870]which can be done in a school setting.
[00:36:50.760]In the clinic setting, it's relatively easy
[00:36:53.400]because usually those services are provided
[00:36:56.400]in a private therapeutic setting.
[00:36:58.527]And so what do we get along with that?
[00:37:00.870]A more individualized focus on that student
[00:37:04.050]and what they're learning and more time.
[00:37:07.140]So most clinical programs that you will see out there are
[00:37:12.750]based upon authorizations from insurance companies,
[00:37:16.080]many of whom are basically taking what the BCBA says
[00:37:21.120]and approving them.
[00:37:22.680]Not all.
[00:37:23.670]There are quality controls in place.
[00:37:25.680]But the benefits are very, very generous,
[00:37:29.040]up to perhaps 30 hours a week, in some cases,
[00:37:33.330]of time for that student, that child, to receive services.
[00:37:38.730]And again, that shouldn't be considered a blanket statement,
[00:37:42.420]but that is the reality for many of our families,
[00:37:46.200]is that they are receiving approvals
[00:37:48.600]once they get in there and are able to receive
[00:37:51.270]that amount of services.
[00:37:52.680]And truly the focus is on behavior.
[00:37:54.600]And we think about what is the barrier to access.
[00:37:57.780]Oftentimes it is those socially significant behaviors
[00:38:01.380]the student is demonstrating.
[00:38:04.200]So how I want to sort of drill this down
[00:38:07.620]is it comes down to perceptions.
[00:38:10.530]And perceptions can then guide the misunderstandings,
[00:38:15.930]maybe even some of the trouble we get into
[00:38:18.750]when we try to bring these entities together.
[00:38:23.940]So on the one hand, schools have an obligation,
[00:38:26.490]and that obligation is FAPE,
[00:38:28.500]free and appropriate public education.
[00:38:31.530]That is what schools are obligated to do
[00:38:34.020]for students with disabilities that qualify under IDEA.
[00:38:38.370]And then on the other side is the clinic,
[00:38:41.790]the outside ABA agency.
[00:38:45.150]And they are bound to provide effective treatment
[00:38:48.690]to their clients.
[00:38:50.280]And a lot of this is controlled by regulations
[00:38:54.330]that happen from our national board,
[00:38:56.400]but also from the insurance companies
[00:38:59.130]that are funding this treatment for these individuals.
[00:39:04.140]What we see in the middle is this,
[00:39:06.570]and that's why I put the little orange arrow,
[00:39:09.690]is we see that perceptions can be very different
[00:39:12.660]about what is required and what is the purpose.
[00:39:15.390]And that's really what I'm hoping to get at
[00:39:17.790]for the rest of today and into next week,
[00:39:20.670]is how do we start to build a bridge to create better,
[00:39:24.660]more accurate perceptions of what we can do
[00:39:27.510]and what we should be doing?
[00:39:29.340]So here's a scenario,
[00:39:31.230]and I'm going to read this just for the sake of time.
[00:39:34.380]You're welcome to read it with me.
[00:39:37.110]A middle school team is struggling to come
[00:39:38.940]to agreement on the contents of an IEP
[00:39:41.880]and FBA for a sixth grader who has challenging behaviors
[00:39:45.300]and autism spectrum disorder.
[00:39:48.030]They call in a consultant who is also a BCBA.
[00:39:51.120]The BCBA does an FBA and PBIP with the team's input.
[00:39:54.480]However, it was notable that the parent
[00:39:56.160]and outside BCBA declined to provide any information,
[00:39:59.910]would not share their treatment plan,
[00:40:01.590]and declined an observation
[00:40:02.970]by the district's consulting BCBA to draft the plan.
[00:40:06.570]At the share-out IEP,
[00:40:08.010]the family's BCBA sits at the end of the table
[00:40:10.740]with the parent and does not make eye contact.
[00:40:12.780]She appears uncomfortable and annoyed.
[00:40:15.240]After the meeting, the team receives word
[00:40:17.340]that the parent was told by the outside BCBA
[00:40:20.250]that the school team has no idea what they're doing.
[00:40:23.190]In addition, she says that the FBA/PBIP is "not scientific,"
[00:40:27.750]that she, parent, should not agree
[00:40:29.700]unless a new FBA is written by her, by the outside BCBA.
[00:40:34.260]The team remains fractured, does not move forward,
[00:40:37.440]as the parent hires an attorney and declares stay put.
[00:40:41.250]The parent wants the outside BCBA
[00:40:44.610]to rewrite the FBA mirrored on their treatment plan.
[00:40:49.110]So this scenario might sound like something
[00:40:53.250]you've dealt with before.
[00:40:54.360]It's something I've dealt with before.
[00:40:56.490]And I will say this right off the bat.
[00:40:58.230]For every negative scenario,
[00:41:00.150]we know there are 100 positive ones.
[00:41:02.490]So just know that these are selected
[00:41:05.340]so that we can really tease out what we need
[00:41:07.740]to work through.
[00:41:09.090]So when you as school districts are encountering
[00:41:14.070]a situation like this,
[00:41:16.170]besides the questions you should be asking,
[00:41:18.660]such as, "Did we properly identify the target behaviors
[00:41:23.130]in the FBA?
[00:41:24.390]Did we do all the things we need to do for the FBA?
[00:41:27.180]Was everyone's input included? Are we following that?"
[00:41:30.870]so once we put that aside,
[00:41:32.970]then we need to start thinking about why is it
[00:41:36.240]that the parent said what she said.
[00:41:39.120]And so then the questions we should be asking are these:
[00:41:42.450]Does that BCBA have any experience with school teams
[00:41:46.320]or any training in what school is?
[00:41:49.770]And really, this is not a condemnation of that person,
[00:41:54.630]but it could be that they do not have that training.
[00:41:59.370]Do they understand special education,
[00:42:02.250]both procedure and substance,
[00:42:04.620]the two things we need to be thinking about
[00:42:06.630]when we provide a FAPE?
[00:42:08.610]Do they understand the IEP
[00:42:11.670]and what specially designed instruction is?
[00:42:14.400]And then what is being messaged to the parents?
[00:42:16.950]So as a school team, we have to be thinking,
[00:42:20.497]"Okay, how did we get here?
[00:42:22.110]What happened in order for this messaging,
[00:42:25.380]whatever it is, to change the parent's mind?"
[00:42:29.640]The next thing we need to do is to think
[00:42:32.610]as an IEP team and to ask these questions of ourselves.
[00:42:37.950]And one thing you should know about that situation.
[00:42:40.980]There were a lot of hard feelings between the IEP team
[00:42:45.960]and the parent and BCBA.
[00:42:47.940]So this was not a good healthy working relationship at all.
[00:42:52.500]So one of the next questions
[00:42:54.120]that the school team might want to be thinking about is,
[00:42:58.740]do we as a team understand the role of that BCBA
[00:43:02.940]in the student's life outside of school?
[00:43:05.280]So what exactly is it that the family is accessing?
[00:43:10.500]And does the team understand what ABA is?
[00:43:15.060]Do they really understand what it is that's going on
[00:43:17.250]and know in this situation there was a barrier
[00:43:20.130]in terms of a lack of collaboration and cooperation?
[00:43:24.330]But I would then come back and say,
[00:43:26.910]is this team committed to providing an offering of FAPE,
[00:43:31.470]regardless of this posturing that was happening?
[00:43:34.200]And how does the team move forward?
[00:43:36.390]And I'm sort of putting this teaser out
[00:43:38.460]because that's exactly what we're going
[00:43:39.930]to look at next Wednesday through a couple of cases,
[00:43:42.450]is, okay, how do we do that when we're at this impasse
[00:43:46.800]and we really can't move forward?
[00:43:49.500]So I would pose that for now,
[00:43:52.710]you think about some non-negotiable values
[00:43:56.370]that need to be held, moving forward.
[00:43:58.830]And that is, as a school team and as a BCBA
[00:44:03.390]who either works alongside the team,
[00:44:06.870]as a part of the team, or other,
[00:44:09.060]the school has to provide a FAPE.
[00:44:11.850]That's their job. They have to do that.
[00:44:13.680]So the IEP team has a requirement
[00:44:16.080]to offer a free and appropriate public education
[00:44:19.200]to the student.
[00:44:20.910]They don't have a responsibility
[00:44:23.280]to implement that outside treatment plan.
[00:44:25.440]So in the situation I shared a little while ago,
[00:44:31.560]well, just a few minutes ago,
[00:44:32.940]there's this expectation somehow
[00:44:34.860]that that outside treatment plan is superior.
[00:44:39.210]The district doesn't need to do that.
[00:44:41.370]Now, all of us that work in school district situations know
[00:44:45.630]that occasionally we will have something called an IEE,
[00:44:48.540]or an independent educational evaluation,
[00:44:51.690]and the district needs to meet and consider what is in that.
[00:44:56.610]And they don't have to implement it.
[00:44:58.380]They have to meet and consider
[00:44:59.730]and then send notice to the family that they did.
[00:45:02.790]So one thing to always keep front and center is,
[00:45:06.090]yes, that child may be getting,
[00:45:09.270]they may be having a treatment plan implemented
[00:45:12.150]in some way or another.
[00:45:13.440]It doesn't mean that we have to implement
[00:45:16.830]that treatment plan.
[00:45:18.720]But the IEP team would do well to figure out
[00:45:22.680]how to engage the parent
[00:45:24.780]and to increase the input that they feel.
[00:45:28.440]And one thing I will say is that outside services tend
[00:45:32.670]to provide parents with what they consider
[00:45:36.750]to be their input,
[00:45:38.430]like having someone on their side.
[00:45:40.710]Parents value that.
[00:45:42.210]So we should be thinking about how we could move forward
[00:45:47.010]with the variables that we have:
[00:45:49.650]an outside provider, the family, and the school.
[00:45:54.000]One thing that I would encourage schools
[00:45:55.680]to be thinking about is what clinical services offer
[00:45:59.460]and what they look like,
[00:46:00.930]and then to understand their own boundaries with ethics.
[00:46:03.870]So for example, in a clinical setting,
[00:46:07.290]consent for assessment is actually a little more rigorous
[00:46:11.370]than it is as part of the IDEA process.
[00:46:14.580]And that can become an ethical issue.
[00:46:17.130]So for the school,
[00:46:19.020]one piece of advice I would always give
[00:46:21.180]is try to understand what, first of all,
[00:46:24.450]BCBAs need to do ethically.
[00:46:27.510]What is happening out in a clinic?
[00:46:29.160]Maybe even go visit and observe in a clinic
[00:46:31.410]if you're given permission to do that.
[00:46:33.210]So what are the private clinical ABA non-negotiables?
[00:46:38.280]For those of you that are in the room
[00:46:39.690]that might be representing that group of people,
[00:46:43.890]I empathize with you.
[00:46:46.260]As we are dealing with two different entities,
[00:46:50.190]we all want the same thing,
[00:46:51.780]but we might have different perceptions
[00:46:53.610]and ways to get there.
[00:46:55.050]One of the things that clinical staff on the ABA side need
[00:46:59.310]to know is that there's a different culture in the schools.
[00:47:03.210]There's a different set of practices
[00:47:05.670]that legally have to be followed.
[00:47:09.000]They just do. That's just part of how it works.
[00:47:11.760]So we have to understand that.
[00:47:13.890]And for those of you BCBAs, if you don't,
[00:47:16.530]then you need to access that training.
[00:47:19.020]And the other thing is when we walk into the school setting,
[00:47:22.530]to really appreciate and respect
[00:47:25.260]that the school has expertise,
[00:47:28.950]that they are trying their best,
[00:47:32.550]to support students that have complex needs.
[00:47:36.540]And here's the other thing,
[00:47:38.130]is that clinics should attempt, at all possible,
[00:47:42.120]to work around school hours.
[00:47:44.340]More to come on that next week
[00:47:45.930]when I talk about what do you do if a parent says to you,
[00:47:48.397]"I can only get services during the day."
[00:47:50.970]So if possible,
[00:47:52.920]those of us that are BCBAs that work privately,
[00:47:55.680]we need to try to respect the school hours
[00:47:58.530]and to avoid offering services during that time.
[00:48:03.660]Okay, so, Sarah, you asked a great question.
[00:48:07.260]What training is available for BCBAs
[00:48:09.420]to better understand the culture and practices of schools?
[00:48:12.570]Now, I tend to, for example,
[00:48:15.120]give the IRIS modules just on, you know,
[00:48:18.060]what is special education?
[00:48:20.010]What are IEPs?
[00:48:21.570]And I don't know if you're familiar with those.
[00:48:23.760]They come out of Vanderbilt.
[00:48:24.900]They're very good, they're free.
[00:48:26.970]Those are some of my first go-tos,
[00:48:29.670]and that would be where I would say you should start.
[00:48:32.970]And I hope that answered your question.
[00:48:35.130]We have to, as clinical providers,
[00:48:39.240]think about collaboration as the ultimate goal.
[00:48:43.650]Parents tend to trust outside providers
[00:48:47.100]even more than schools.
[00:48:48.930]So we have the ability to change that dynamic considerably.
[00:48:53.730]Considerably. Excuse me.
[00:48:55.200]And then, also, we need to be thinking,
[00:48:58.620]so one of the things
[00:48:59.610]that clinical people are always thinking about
[00:49:02.340]is we are going to deliver what we consider
[00:49:06.150]to be high-quality interventions,
[00:49:08.610]but promoting generalization to multiple environments.
[00:49:12.930]And that will get us into, well,
[00:49:15.270]why are we even talking about ABA providers coming
[00:49:18.390]into schools?
[00:49:19.223]So more to come on that as well.
[00:49:21.930]So good question that was asked about that.
[00:49:24.870]I am now at about nine minutes left.
[00:49:28.710]So I am now going to open it up for your questions
[00:49:33.120]that might have been coming from Q&A
[00:49:36.240]in the room or just in general.
[00:49:41.520]What can a school do when a child
[00:49:43.740]is missing two and a half hours of school every day due
[00:49:47.010]to leaving for ABA therapy?
[00:49:49.020]It's actually something I'm going to address next week,
[00:49:51.390]but I will say that this is a situation
[00:49:55.440]that I wish would never happen.
[00:49:57.540]And again, if we're going to agree on the premise
[00:50:00.540]that school is the natural environment for children,
[00:50:03.060]if that child is missing out on any part
[00:50:07.260]of what would be offered in IEP,
[00:50:11.310]that is an issue that we need to address
[00:50:13.830]by getting together and discussing
[00:50:15.840]how can we make sure that this child is in school
[00:50:19.770]so they're receiving those hours
[00:50:21.810]that are outlined in the IEP.
[00:50:24.600]You know, in a situation like this,
[00:50:26.430]the first thing I would ask is,
[00:50:27.900]is this because this was the only time that was available?
[00:50:32.460]Many parents are waiting for months or longer
[00:50:36.480]to receive services.
[00:50:37.710]So when they do, they tend to say,
[00:50:40.087]"I'll take whatever I can get."
[00:50:42.240]And I don't know if that's the situation
[00:50:44.910]that you're describing,
[00:50:46.080]but most of the time that is what is happening.
[00:50:49.320]So what I would say in answer to that is get together
[00:50:52.680]and try to figure out, is that what is going on?
[00:50:56.340]Is that impeding that child's ability to access a FAPE?
[00:51:00.570]And then discuss, okay, how do we move forward?
[00:51:03.420]Can we change so that services are offered in the afternoon,
[00:51:08.160]so that the child is in school and accessing peers,
[00:51:12.570]opportunities to generalize social skills,
[00:51:15.120]and opportunities just to be in other settings
[00:51:18.240]that cannot be replicated in the clinic?
[00:51:23.550]Okay, so then another question came from Terry.
[00:51:26.910]Can you address the lack of opportunity
[00:51:28.950]for generalization of skills in the clinical setting?
[00:51:32.280]It seems like a big topic in the development.
[00:51:34.470]Learning of a child that does not get much attention.
[00:51:36.840]So I am assuming what you are saying
[00:51:39.510]is that when a child's in the clinic,
[00:51:41.070]they aren't able to generalize.
[00:51:43.680]Is that what you're saying?
[00:51:48.600]And maybe just a quick yes.
[00:51:51.000]Yes. Okay.
[00:51:52.671]I agree with you that there's a limit to this,
[00:51:56.640]and I think we need to talk about that.
[00:51:58.500]So the best way to do that
[00:52:00.330]is to get together with that clinic,
[00:52:03.510]with the team, and say,
[00:52:06.067]"Listen, generalization is the goal.
[00:52:09.870]There aren't any peers in the clinical setting.
[00:52:13.140]How are we going to generalize these skills
[00:52:16.140]to a setting in which they're being practiced with peers,
[00:52:19.650]they're being practiced with other teachers?"
[00:52:22.260]I think that's where we need
[00:52:23.190]to actually just call it out like it is
[00:52:25.020]and have the conversation.
[00:52:30.060]Okay. And then let's see.
[00:52:32.580]Carissa said, what might, excuse me,
[00:52:36.600]I'm having a hard time getting this to scroll down.
[00:52:39.090]What might the school team consider
[00:52:41.340]for a clinic ABA provider who wants to come into the school
[00:52:45.630]to provide services?
[00:52:47.250]So next week I'm going to discuss four scenarios
[00:52:52.350]in which something like this happens.
[00:52:54.900]So if you've got a provider
[00:52:57.000]that wants to come into the school,
[00:52:59.160]I think that there are many, many questions
[00:53:03.480]that need to be raised about this.
[00:53:05.640]Is this because they want to observe,
[00:53:09.630]to see whether or not the child is generalizing skills
[00:53:12.870]to that setting?
[00:53:14.580]That might be one reason.
[00:53:15.960]Or do they want to come in and provide services
[00:53:19.080]because there are technicians available
[00:53:24.000]during the school day, but not after school?
[00:53:27.330]And so if the case is it's about availability,
[00:53:30.930]I think that's questionable,
[00:53:32.430]especially if insurance is paying for that time.
[00:53:35.610]So for me, the best thing to do is to get together and say,
[00:53:39.637]"What's the goal?
[00:53:41.130]Why are you asking for this?
[00:53:45.060]Why does it need to be in school versus after school?"
[00:53:48.840]And just get more information about what the ask is.
[00:53:52.380]So next week,
[00:53:53.610]I'm going to be presenting a problem solving tool
[00:53:57.360]to help when things like this get posed to you
[00:54:00.660]as providers and then decide.
[00:54:04.050]You can decide how you use it,
[00:54:05.820]but basically to go through a process
[00:54:07.740]of determining what do you say in response to that.
[00:54:14.130]And I will say, too, that in, you didn't ask,
[00:54:18.120]but I was going to say it,
[00:54:19.590]there is a place for BCBAs to be in school settings,
[00:54:23.520]and what could be an alternative solution
[00:54:27.510]is to have the district BCBA design interventions
[00:54:31.290]that could be done during the day
[00:54:33.630]and that could be implemented by staff
[00:54:35.460]that are already there.
[00:54:36.690]To me, that seems like a much more scalable system
[00:54:41.640]that can be done across all settings
[00:54:44.550]rather than just having a private provider come in.

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Applied Behavior Analysis (ABA) Therapy in Schools for School Administrators and School Staff Part 1

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