Applied Behavior Analysis Therapy in Schools for School Administrators and School Staff Part II

Vanessa Tucker Author

04/11/2024 Added

8 Plays

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[00:00:06.570]Good afternoon.
[00:00:07.560]Can you hear me?
[00:00:10.710]Yes.
[00:00:11.790]Great.
[00:00:12.660]Well, thank you for the warm welcome.
[00:00:14.610]Coming to you from Washington State,
[00:00:16.620]and it's good to see that some of you are back.
[00:00:19.530]I am very excited to continue this discussion,
[00:00:23.880]so hopefully you're here for the same reason as me
[00:00:27.660]in wanting to do better in collaborating with our partners,
[00:00:32.280]whether our partners, our school, or BCBAs
[00:00:36.570]that work with them.
[00:00:38.610]So without further ado,
[00:00:39.960]I'm going to go ahead and get started.
[00:00:41.610]If there are questions, Annette or Megan,
[00:00:45.120]that you feel I I need to answer,
[00:00:47.460]go ahead and just let me know,
[00:00:49.020]and I'll gladly take a pause and try to address that.
[00:00:53.550]So, what I wanna do today
[00:00:54.900]is a little bit different in scope.
[00:00:56.730]We talked quite a bit last time about,
[00:00:59.700]well, what is a behavior analyst,
[00:01:02.857]and how do they practice in a clinical setting,
[00:01:05.457]and what makes that different from
[00:01:07.230]practicing in a school setting?
[00:01:09.360]So if you were not in attendance at part one,
[00:01:13.020]I would encourage you to go back and view that
[00:01:15.600]because I think we need to start there
[00:01:17.340]with determining what is the scope.
[00:01:19.860]And I don't mean scope of competence.
[00:01:21.450]I mean the scope of practice in each setting.
[00:01:25.380]So if we are moving beyond that to,
[00:01:28.770]okay, now we recognize that
[00:01:31.440]there may potentially be different scopes
[00:01:33.630]of practice and policies in different settings.
[00:01:36.270]We need to move on to the what do we do about that?
[00:01:39.510]And what I'd like to do today
[00:01:41.670]is to give you a framework
[00:01:43.290]and then model it for you in a couple of different ways
[00:01:45.960]based on some real scenarios.
[00:01:48.150]And I'll just throw it out there that if you are a BCBA
[00:01:51.660]and you're attending today
[00:01:53.490]and you're wanting to know more about
[00:01:55.170]how do I partner with schools,
[00:01:56.820]some of the things they do
[00:01:57.960]are just not meshing with my understanding,
[00:02:00.120]and I need to make sure and do the right thing,
[00:02:03.480]then the two trainings in April are really for you.
[00:02:06.510]But I would encourage others to attend as well,
[00:02:08.820]just in case you're wondering
[00:02:10.080]what people are thinking and wanting.
[00:02:12.240]So we'll start here with is some general
[00:02:14.400]foundational touchpoint.
[00:02:16.710]One of the first ones that I will offer is that schools,
[00:02:20.640]meaning school districts and agencies, have to offer a FAPE,
[00:02:24.690]or a free and appropriate public education,
[00:02:28.290]to all students that are on
[00:02:29.850]an individualized education plan.
[00:02:32.130]I think we start here,
[00:02:34.320]especially when we're thinking about
[00:02:36.900]the expectations of people
[00:02:39.480]in every single setting we've discussed,
[00:02:41.760]whether that's the school setting
[00:02:43.440]or people on the outside in the clinical setting.
[00:02:46.620]And what that might include is ABA services
[00:02:50.880]in some way or another.
[00:02:53.100]One of the things that we touched on
[00:02:55.050]quite deeply in the first session is that
[00:02:58.350]ABA is often mischaracterized as being something separate,
[00:03:02.370]something completely different from
[00:03:05.100]what schools might already be doing.
[00:03:07.320]And so we spent some time talking about the fact that
[00:03:10.770]ABA is a set of scientific principles that
[00:03:14.070]when applied to socially significant behavior
[00:03:17.490]should result in meaningful behavior change.
[00:03:21.000]And then I would have you think about the following.
[00:03:25.200]We are already applying some of these principles
[00:03:30.090]to the things that we do in schools.
[00:03:32.400]So these services might already be
[00:03:34.560]embedded in the instruction that we provide.
[00:03:36.900]So if we think about direct instruction,
[00:03:39.870]of course the principles of systematic instruction
[00:03:44.190]and database interventions are baked in that,
[00:03:47.190]or behavior supports.
[00:03:48.540]When we do things like a token system,
[00:03:51.720]or we provide a group-based contingency,
[00:03:55.620]or we work really hard on having a ratio of
[00:03:58.920]five positives to one negative,
[00:04:01.770]those are all based on principles
[00:04:03.750]from applied behavior analysis.
[00:04:05.310]I think we need to get away from
[00:04:07.680]this idea that ABA is something so magical and different
[00:04:11.880]that we have to bring it in from the outside.
[00:04:13.830]I would say that that's really not true.
[00:04:16.530]So that is the first thing that I want you to take away.
[00:04:20.700]That is a good through line from the first training to now.
[00:04:24.870]And then as we move forward into thinking
[00:04:27.600]more about what might ABA look like in the school setting,
[00:04:32.250]it can be provided in various ways.
[00:04:34.440]So let's say for example,
[00:04:36.480]you have a small group of students
[00:04:38.880]that's demonstrating some challenging behavior.
[00:04:41.520]Maybe it's with getting on task
[00:04:43.740]or staying on task or being motivated to do the work.
[00:04:47.430]We might apply some principles such as
[00:04:51.210]let's reteach the routines and expectations.
[00:04:55.320]Let's provide higher levels of reinforcement,
[00:04:58.470]let's make the work more fun,
[00:05:00.540]let's make sure that we offer something tangible
[00:05:03.360]that the kids like afterwards.
[00:05:05.970]Those are ways that we're applying
[00:05:07.980]the basic principles upon which ABA is based.
[00:05:11.370]Now, it also could be something more along the lines of
[00:05:15.990]an individual student has more complex needs,
[00:05:19.440]and then we think about, well, for that student,
[00:05:23.400]what does their program look like?
[00:05:25.020]What does FAPE look like for them?
[00:05:26.850]It could be very different
[00:05:27.960]than what works for most other students.
[00:05:30.810]So what that might involve is us then
[00:05:33.900]looking at other agencies,
[00:05:35.970]and that could be anything from
[00:05:39.270]the students already getting services,
[00:05:41.460]and we are just partnering with them
[00:05:43.950]to having an agency provide some contracted work.
[00:05:47.610]And really it's very situationally dependent.
[00:05:52.800]So as with anything else,
[00:05:55.260]it's totally dependent on what data is showing.
[00:05:58.830]And that to me is a very important thing to keep in mind.
[00:06:03.600]If something is working,
[00:06:05.520]we don't need to add something else to it.
[00:06:07.800]But if we try things
[00:06:09.510]and we know that it isn't working,
[00:06:12.210]then we need to demonstrate we tried something else,
[00:06:15.210]and then whether or not that works again
[00:06:16.980]is a basic data answer,
[00:06:19.710]and that comes from progress monitoring.
[00:06:22.200]And also, the services that we provide to students
[00:06:26.130]should be informed through parent input.
[00:06:28.380]And one of the things we talked about last week
[00:06:31.470]was that oftentimes parents will come in
[00:06:34.770]with their outside providers
[00:06:37.170]simply because there is a lack of trust
[00:06:40.320]or a feeling of a lack of collaboration.
[00:06:43.800]So this is just setting it up for...
[00:06:46.020]This is what we talked about first.
[00:06:48.000]It's a very small part of that.
[00:06:50.160]How is that going to inform what we do now?
[00:06:53.400]So I wanna start by kind of mapping out
[00:06:57.660]more of a continuum of what this might look like.
[00:07:01.170]So let's think first about private ABA services,
[00:07:04.680]recognizing, first of all, I should say,
[00:07:07.680]whether a BCBA is working in a school
[00:07:11.460]or working in private clinical practice.
[00:07:14.580]They both have the same training
[00:07:17.130]in terms of we're all held to the same standards,
[00:07:20.070]we're all held to the same ethics.
[00:07:22.800]We may have a different scope of practice,
[00:07:26.010]meaning that in a school setting,
[00:07:28.410]the true meaning of a related service is access.
[00:07:32.370]In a clinical setting, it is different.
[00:07:35.850]There's more leeway and room for what is possible.
[00:07:39.750]So let's look at how this trajectory might go.
[00:07:42.630]First of all, it could be that a student,
[00:07:44.970]a client is receiving services outside of the school day.
[00:07:49.560]So that could be in the morning,
[00:07:51.330]could be in the afternoon after school,
[00:07:54.660]it could be in the evenings, it could be on weekends.
[00:07:57.210]Sometimes what that looks like is school services such as...
[00:08:02.250]We have spring break coming up in a few weeks
[00:08:04.410]in my daughter's district.
[00:08:05.850]And maybe during that time,
[00:08:07.590]some of those hours are utilized during that time.
[00:08:11.340]So that's one way that it could look.
[00:08:13.830]But another way and a way that I think is common
[00:08:17.220]and something that we grapple with in schools is,
[00:08:19.410]what if an outside provider
[00:08:22.200]wants to come into the classroom?
[00:08:24.780]And I get asked that all the time.
[00:08:26.640]What do we do in those situations?
[00:08:28.350]Is that okay to do?
[00:08:29.400]What's the purpose of that?
[00:08:31.800]Why would they want to do that?
[00:08:34.200]And what are the implications?
[00:08:36.210]So as you are moving along,
[00:08:38.760]if you are a school administrator,
[00:08:41.250]you are having these questions.
[00:08:42.780]And I'd like to talk a little bit about
[00:08:44.580]what the purpose is of these in just a second.
[00:08:47.910]It could be that services are provided in school,
[00:08:52.140]and this could be by an outside provider.
[00:08:55.080]So we do see situations in which
[00:08:57.690]the outside ABA provider has either been
[00:09:00.900]contracted by the district
[00:09:03.150]or the insurance company is paying for this person or team
[00:09:07.980]to work alongside that student and their team
[00:09:10.650]during the school day.
[00:09:13.140]Okay, so the services are in school in the third point.
[00:09:17.490]And the fourth point is that
[00:09:20.520]the services are provided in a clinic
[00:09:22.650]by the provider during the day.
[00:09:25.320]And my preference of course, always,
[00:09:29.160]and I believe I said this maybe a couple times
[00:09:32.010]during the first presentation,
[00:09:33.810]is the natural environment
[00:09:35.280]for school-aged children in school
[00:09:37.260]for a lot of reasons,
[00:09:39.060]not one of which that is...
[00:09:40.740]I think the most important would be inclusion
[00:09:43.590]and wanting students to be around their peers
[00:09:46.500]in a normalized setting as much as possible.
[00:09:48.900]Still, this is the what is possible in the scenario.
[00:09:53.700]Here is the thing I want you to be aware of.
[00:09:56.220]And I'm gonna use the, hopefully this will work.
[00:09:59.040]I don't know how that works in a webinar,
[00:10:00.510]but we'll try it.
[00:10:01.830]I wanna use the spotlight here.
[00:10:04.110]So I want you to note this nice red rectangle down here.
[00:10:09.390]All the services here are guided by a treatment plan.
[00:10:13.830]Now let me have a caveat to this.
[00:10:15.900]So the treatment plan is a plan that is developed
[00:10:19.710]in order to get insurance authorization.
[00:10:22.920]It's not an IEP.
[00:10:23.753]It's not the same thing as an IEP.
[00:10:26.010]It is designed to
[00:10:28.650]basically provide services
[00:10:31.800]because they are medically necessary.
[00:10:34.440]So if we're looking at services provided
[00:10:37.170]outside of the school day in home or clinic,
[00:10:39.810]that's based on the treatment plan.
[00:10:42.630]If the provider is wanting to come in and observe,
[00:10:46.230]they're still operating on the treatment plan.
[00:10:49.020]If services in school are provided by the outside provider,
[00:10:53.400]maybe not.
[00:10:54.990]And we're gonna talk about a scenario
[00:10:56.790]in which we have to decide.
[00:10:58.290]So while the alongside part is paid for by that insurance,
[00:11:05.670]in the school setting,
[00:11:06.810]we have to start thinking about
[00:11:08.610]what plan is guiding the work,
[00:11:10.560]and I'll get to that in a minute.
[00:11:12.180]But certainly this last one on the right hand side,
[00:11:15.510]if the student is inside the clinic all day,
[00:11:19.050]by far, the first plan to be considered
[00:11:23.610]would be the treatment plan, caveat being this.
[00:11:27.570]If, for example, the district said,
[00:11:30.037]"We're gonna contract with this clinic
[00:11:32.160]to provide services all day in the clinic,"
[00:11:35.160]and the district is going to provide for
[00:11:38.640]educational services in some way,
[00:11:41.340]then we would say it could be both.
[00:11:44.940]So in each of these, know that,
[00:11:47.940]when it comes to private outside ABA,
[00:11:50.640]that treatment plan is guiding the work.
[00:11:53.910]But inside school,
[00:11:55.200]we have a very different scenario going on.
[00:11:57.900]So I'll go ahead and close the annotation for now,
[00:12:01.500]but I might use that tool again.
[00:12:02.820]We'll see how that goes.
[00:12:04.380]So let's talk about what is possible in school,
[00:12:07.350]and I want to actually start with
[00:12:10.530]that green round rectangle down at the bottom.
[00:12:14.520]The IEP is the guide,
[00:12:16.350]and this is something that can get lost in translation
[00:12:20.910]when you're dealing with someone who is untrained,
[00:12:23.940]who doesn't understand the policies,
[00:12:27.180]the requirements of the school to provide FAPE.
[00:12:30.297]And it's not just for services,
[00:12:32.070]it's about placement and intensity.
[00:12:34.740]So I know I'm speaking to the choir here right now,
[00:12:37.680]but obviously the IEP guides the services.
[00:12:41.097]And so let's talk about this
[00:12:42.990]in terms of this continuum of what is possible.
[00:12:45.900]So once again, I'll get this little spotlight out
[00:12:49.980]and actually maybe I'll try an arrow instead.
[00:12:52.320]So how might this look?
[00:12:54.330]Look a lot of different ways.
[00:12:56.100]One of the ways it might look is on the left.
[00:12:58.200]There might be some behavior consultation
[00:13:00.630]by a school ABA staff.
[00:13:02.460]Now what does that mean?
[00:13:03.840]It could be that that person is BCABA,
[00:13:09.120]so an assistant behavior analyst,
[00:13:11.040]or it could be that they're a behavior technician,
[00:13:14.310]or it could be the BCBA themselves.
[00:13:16.680]So it can look a lot of different ways,
[00:13:18.870]depending on who is on the team.
[00:13:21.840]And that behavior consultation can be anything from
[00:13:25.710]helping to more effectively manage a group,
[00:13:28.770]to how to create a robust individualized system
[00:13:35.010]for dealing with aggression or elopement
[00:13:38.970]or other behaviors that we see.
[00:13:40.857]The behavior consultation is usually time-limited.
[00:13:45.870]So you can think of it almost like a tier two,
[00:13:49.110]maybe a tier three intervention,
[00:13:50.610]depending on whether or not you are
[00:13:54.900]characterizing your tier two interventions as short term,
[00:13:58.350]rapid and short term.
[00:14:00.180]So let's look then at the next one.
[00:14:02.130]Short term services by school ABA staff.
[00:14:05.130]And again, I'm purposely using ABA staff
[00:14:07.650]because in many school districts
[00:14:10.830]there will be a, quote unquote, "behavior team,"
[00:14:13.830]which could be small or large depending on where you are
[00:14:17.070]and how many people you have,
[00:14:18.690]or it could be provided by
[00:14:21.420]we call educational service districts in Washington state.
[00:14:25.230]You have something similar where it's a pooled agency
[00:14:28.920]that then supports districts.
[00:14:31.050]So the short term services could look like
[00:14:33.660]what I had just said in the first one,
[00:14:35.880]could be basic consultation,
[00:14:38.430]but it could also be something else.
[00:14:40.770]It could be that there's a functional behavior assessment
[00:14:45.120]and a behavior intervention plan,
[00:14:47.340]and then there's time to implement this plan,
[00:14:50.970]train everybody so that they know how to
[00:14:54.420]implement the interventions that are planned,
[00:14:57.450]respond with the correct reinforcement,
[00:15:00.180]take data and know what to do with it.
[00:15:03.060]And those services are usually designed to be faded.
[00:15:07.080]So could be that there's a structure in place
[00:15:10.530]for a six week time period in which the student is receiving
[00:15:14.100]services with a plan to fade.
[00:15:16.200]Whatever that looks like, it's going to be different,
[00:15:18.390]depending on every single person.
[00:15:20.760]Well, what happens when you've got someone
[00:15:24.150]who needs longer term services,
[00:15:26.430]whose FAPE is dependent
[00:15:28.830]on something that's more restrictive?
[00:15:31.020]Well then we might move to the next scenario,
[00:15:34.260]which could be something more long-term,
[00:15:37.320]and that might mean that BCBA
[00:15:40.530]has a student on their caseload
[00:15:42.990]and serves them a number of hours per week.
[00:15:46.470]Maybe they also deploy a behavior technician
[00:15:50.340]and they supervise them
[00:15:52.200]because we know that not all kids
[00:15:54.480]are going to magically be fine after a certain period.
[00:15:59.010]There are times where we have to consider
[00:16:01.710]that FAPE may something that is more restrictive,
[00:16:06.003]the dose is bigger, and the time period is longer.
[00:16:11.370]Okay, so we have all those pieces that we can consider.
[00:16:14.580]However, it is possible,
[00:16:16.857]and this gets to what I was saying before,
[00:16:19.500]that services in the school
[00:16:21.270]are done by contracted clinical staff
[00:16:24.930]for a wide variety of reasons.
[00:16:26.640]It could be that there's a capacity issue.
[00:16:29.310]So the idea here is we want to have a team,
[00:16:33.570]we think we need a team to support the student.
[00:16:36.720]We don't have those people,
[00:16:38.700]and so we need to then contract with them
[00:16:41.490]from a local agency clinic that
[00:16:45.420]may or may not be that local, by the way,
[00:16:47.040]depending on where it is that your district resides.
[00:16:50.580]But the idea here is that they are providing services
[00:16:55.230]that are outlined in IEP to provide FAPE.
[00:16:59.130]And then of course as we move along this continuum,
[00:17:02.310]we see that services during the day could be in what?
[00:17:06.090]In Washington State, we call it non-public agency.
[00:17:10.440]In other states, you might call it something else,
[00:17:12.480]but just to define that for you.
[00:17:15.450]From my perspective, it's an agency
[00:17:18.150]that is not a public school,
[00:17:20.550]but that receives public funds on contract
[00:17:24.390]to service students.
[00:17:26.070]So it could be you've got local agency here
[00:17:30.510]that is an agency that is not a school,
[00:17:34.710]but they are overseen by
[00:17:37.860]a school district who's their sponsor,
[00:17:40.050]and then students can, on contract, attend that.
[00:17:43.170]So those services could be there,
[00:17:44.910]and we have a number of them in Washington state.
[00:17:47.100]My understanding from talking to some of you out there,
[00:17:51.360]I said that's not as common
[00:17:52.497]and I don't know if that's regional or not,
[00:17:55.440]but it also could look like
[00:17:57.540]the student is served in the clinic
[00:18:00.150]completely away from the school or from a school
[00:18:03.990]and everything in between.
[00:18:05.910]Where it gets sticky
[00:18:08.100]and where we need to do some problem solving
[00:18:10.830]is these two right here,
[00:18:14.880]so the second from the right and the last one on the right,
[00:18:18.450]because we still have to provide a FAPE.
[00:18:21.180]And by we, I'm always talking about the district.
[00:18:24.660]And so if we're having contracted clinical staff coming in,
[00:18:29.460]we still have to provide whatever the FAPE is on the IEP.
[00:18:33.390]So for example, if a student has academic goals on their IEP
[00:18:37.590]and specially designed instruction,
[00:18:39.780]we have to make sure that,
[00:18:42.030]if clinical staff are being contracted,
[00:18:44.850]that student is still contacting
[00:18:46.890]and working with certificated academic staff
[00:18:51.030]or an SLP or OT for their related services.
[00:18:54.027]And the same is true, especially on the right.
[00:18:58.050]Where it gets even more fun is when
[00:19:01.860]clinic staff have a treatment plan
[00:19:04.230]because students also receiving insurance-based ABA,
[00:19:08.790]and there is no such thing as medical ABA.
[00:19:11.070]I established last time that ABA is ABA.
[00:19:14.280]It doesn't matter if it's in school or at home.
[00:19:17.550]It's still the same scientific principles.
[00:19:21.420]So we keep the idea here that
[00:19:24.477]the IEP is our roadmap for FAPE
[00:19:27.690]but there are times where other things come into play.
[00:19:31.350]So we have to have a process for figuring out
[00:19:34.740]what part are they going to play, if any,
[00:19:36.900]and to make sure that all stakeholders understand.
[00:19:40.410]So I will go ahead and stop for just a minute
[00:19:43.410]and see if there are any questions before I move on.
[00:19:54.570]Doesn't look like it,
[00:19:55.590]so I'm gonna go ahead and continue.
[00:19:59.190]So there's a conundrum that I need to call out.
[00:20:03.886]And for those of you in this virtual room that are BCBAs,
[00:20:08.130]and even for those of you that aren't,
[00:20:10.410]it's something that needs to be said.
[00:20:13.110]When we think about outside services for a child,
[00:20:16.290]we might think about a therapist of some kind.
[00:20:19.410]So let's say a cognitive behavioral therapist
[00:20:22.410]to work on issues around psychosocial issues in the family.
[00:20:27.300]It could be a therapist that works on
[00:20:30.840]your fine motor skills outside or speech.
[00:20:33.990]Those services are usually approved
[00:20:37.080]and scheduled at about one to two hours a week maximum,
[00:20:41.610]and that is what insurance approves.
[00:20:44.790]That's how they are delivered.
[00:20:47.460]There really is no other outside service
[00:20:50.520]that is considered medical or habilitative as ABA,
[00:20:55.470]that provides as much therapy time as ABA does.
[00:20:59.040]They're kind of a unicorn when it comes to
[00:21:02.250]thinking about how all this plays out.
[00:21:05.280]So a treatment plan for a typical student
[00:21:09.150]could be 30 to 40 hours a week,
[00:21:12.270]and there isn't another outside service
[00:21:14.640]that provides 30 to 40 hours a week.
[00:21:17.250]You would never find a therapist that would offer
[00:21:20.280]30 hours of therapy unless it was private pay.
[00:21:23.580]And even then, I don't think
[00:21:24.510]there's a therapist that would do that.
[00:21:26.490]So this is in part because of
[00:21:29.670]the legal push to have ABA covered by insurance,
[00:21:33.630]and to make that mandated in all states,
[00:21:36.060]but also, based on research, looking at the number of hours
[00:21:40.950]that somebody needed ABA services
[00:21:44.040]in order to benefit when they had a diagnosis of autism.
[00:21:48.000]So we have this unique situation where
[00:21:51.930]ABA plans can offer to a family
[00:21:55.320]much more than other therapies could ever or whatever do.
[00:22:00.390]And the conundrum continues
[00:22:02.100]because oftentimes what happens is the clinic will say,
[00:22:07.597]"We don't have time before school or after school
[00:22:11.130]to serve your child,
[00:22:12.090]but we do have time during the school day,"
[00:22:15.870]which then leads to families being given the choice of,
[00:22:20.010]well, you can take your child out of school
[00:22:23.610]for part of the day to come in and get these services.
[00:22:28.170]This conundrum looks something like what I put below,
[00:22:31.650]something to the effect of the ABA company said
[00:22:34.170]we are approved for 30 hours a week,
[00:22:36.180]but they only have time during the day right now.
[00:22:39.540]And this leads to some difficult outcomes for families.
[00:22:44.250]For example, a family then has to choose,
[00:22:47.250]do I put my child on a wait list for ABA
[00:22:51.060]and continue on with school?
[00:22:53.070]Do I pull them out for part of the day
[00:22:55.350]so that they can benefit from these services?
[00:22:58.560]Or do I attempt to have my ABA provider
[00:23:02.940]come in during the school day
[00:23:05.220]to provide services while the child's in school?
[00:23:09.120]Either way, this is a situation that is unlike any other
[00:23:14.610]that we've had to contend with as school districts
[00:23:19.560]with very few exceptions.
[00:23:21.570]So this is where we are at right now.
[00:23:24.870]And I wanna go on record saying I don't fault ABA agencies
[00:23:29.610]for being limited in terms of time and staffing,
[00:23:32.850]but I think where we need to go
[00:23:35.220]is with the understanding that
[00:23:37.800]school is the natural environment for kids,
[00:23:39.870]whatever that looks like,
[00:23:41.460]and we should really try to invest in helping families
[00:23:45.870]to understand that.
[00:23:47.670]So this conundrum is part of the reason
[00:23:50.940]why we are even having these discussions.
[00:23:54.030]The good conundrum is that we are, as BCBAs,
[00:24:01.290]increasingly more common in the school setting.
[00:24:04.320]And what I mean by that is
[00:24:06.240]we are being hired by school districts,
[00:24:10.260]or are being welcomed to work alongside districts,
[00:24:14.040]or even to be tapped for some consultation,
[00:24:17.070]none of which is a bad thing.
[00:24:18.990]So hopefully the audience sees
[00:24:20.910]kind of the picture I'm painting here is where we really are
[00:24:25.050]in terms of our kind of the state of the state
[00:24:28.950]that we are in.
[00:24:31.260]Okay, so how do we navigate this?
[00:24:35.400]What do we do when we're at this intersection of
[00:24:39.330]what BCBAs can do in a school for students
[00:24:43.890]and what schools need to be doing for students?
[00:24:48.150]Well, let's take a look.
[00:24:49.710]First of all, I'd like to talk to the school districts,
[00:24:52.200]and I'd like the BCBAs in the room to hear this as well.
[00:24:56.100]The district, inevitably, is responsible for giving a FAPE.
[00:25:01.470]They have to be the ones to do that, no matter what.
[00:25:05.040]So here are some questions
[00:25:07.740]that I would have district asks at the very beginning.
[00:25:11.310]So as a district you might ask this question.
[00:25:15.210]Will you hire a BCBA?
[00:25:17.520]Is it possible that you could do that
[00:25:20.310]as a means of meeting some of these behavioral needs?
[00:25:24.120]And I would advocate for that.
[00:25:25.950]I think that's a wonderful way
[00:25:27.510]to be able to add a level of behavior support
[00:25:32.670]to what you're already doing, to what you're offering.
[00:25:34.920]So that's a question.
[00:25:36.030]And if you did that, how would that look?
[00:25:38.910]So some things that you might wanna be thinking about
[00:25:41.970]if you're the district people in the room is,
[00:25:44.550]will the BCBA be the head of a behavior team?
[00:25:49.290]And will he, she, or they be deploying people out
[00:25:54.270]and then supervising them in doing tier three interventions,
[00:25:58.470]tier two interventions?
[00:25:59.580]So how would that look?
[00:26:01.860]And as I was saying, I am from Washington,
[00:26:05.820]and we're seeing an increase in BCBAs being hired
[00:26:09.990]to work for school districts
[00:26:11.520]and to have behavior technicians that work with them.
[00:26:14.700]So it's really something that
[00:26:16.350]is a matter of design and choice for your district,
[00:26:19.110]and it's a way of kind of heading off with,
[00:26:21.240]yeah, we recognize that that would be a wonderful support.
[00:26:24.990]So let's go on to see.
[00:26:26.550]What if you decided to partner with outside agencies?
[00:26:30.780]If you did that, what policies are needed?
[00:26:34.650]And I ask that because, oftentimes,
[00:26:38.040]what I'm seeing is the policy is a blanket nobody comes in.
[00:26:42.960]We're not partnering.
[00:26:44.370]We're not having observations.
[00:26:46.410]we're not doing anything.
[00:26:48.270]And when that happens, I think districts actually are taking
[00:26:51.990]a very shortsighted view of how they could potentially
[00:26:56.850]be sending a message that they don't want to
[00:26:59.820]engage with families and support them in their efforts
[00:27:02.760]to meet their child's needs.
[00:27:04.710]So to be thinking about that I think is a wise move.
[00:27:09.090]Now, if you did partner,
[00:27:11.130]if you decided to partner with
[00:27:13.410]all agencies that they're allowed to come in,
[00:27:16.680]what will that look like?
[00:27:17.850]And when would you say no?
[00:27:19.979]And of course as a district, it's okay to say no.
[00:27:22.890]If there's a situation where it is denying a FAPE
[00:27:26.820]or it is impeding staff to work
[00:27:29.580]or it is creating some other hardship,
[00:27:32.730]saying no is the obvious choice
[00:27:34.740]for a district administrative team.
[00:27:37.380]Now the next one, E, is very important.
[00:27:40.650]We have to think about complex kids
[00:27:43.290]and the continuum of services that they might need.
[00:27:46.350]So having some decision rules around,
[00:27:49.350]all right, when do we say it's time to contract out
[00:27:54.150]because we need this person to come in
[00:27:56.190]and support a program,
[00:27:57.660]or we need this person to come in
[00:28:00.600]and support this student, either short or long term.
[00:28:04.410]This is sort of a laundry list to be thinking about.
[00:28:06.810]And then, ultimately, each time we have a situation like E,
[00:28:12.600]we need to think about whether a reevaluation should occur
[00:28:16.320]because we're talking about adding on a service
[00:28:18.870]and really kind of trying to rectify
[00:28:21.630]what's the barrier and what's the need here.
[00:28:23.610]So reevaluating is a smart choice.
[00:28:26.820]Creating a new IEP that reflects that,
[00:28:29.400]also a very smart choice.
[00:28:31.560]Okay, so that's for the districts in the room there.
[00:28:35.040]Any questions from district personnel before I move on?
[00:28:44.400]Okay, if not, I will continue.
[00:28:46.613]This is good because we have a lot to cover.
[00:28:49.710]Not that you can't talk because you certainly can,
[00:28:52.140]but just some general advice that I would give you.
[00:28:55.920]This is something that I think
[00:28:59.266]our district friends need to know is that
[00:29:02.070]the ABA providers that you work with, it is...
[00:29:07.920]I think the assumption's out there
[00:29:09.240]that they understand school laws and policies,
[00:29:11.670]and that when they make a mistake, they did it on purpose.
[00:29:14.610]And so I will come forth as the Pollyanna to say,
[00:29:18.930]I wouldn't assume that.
[00:29:20.370]I would not assume that they understand
[00:29:22.350]school law and policies.
[00:29:23.700]And if there is a mistake,
[00:29:25.050]it's probably on us to provide training
[00:29:29.130]so that they understand
[00:29:30.450]this different culture that they're working in.
[00:29:33.150]There are some that do,
[00:29:34.740]but I would say that the larger majority do not.
[00:29:38.340]Now, the other assumption that I see is the second one
[00:29:41.430]that the parent asks for ABA involvement,
[00:29:43.890]meaning that there's the assumption
[00:29:45.780]that the district is failing to provide services.
[00:29:47.987]That's not always true.
[00:29:49.380]I think sometimes the parents are just looking for
[00:29:52.440]that nice cross collaboration that they would like to see
[00:29:55.710]between their provider and the school setting.
[00:29:59.220]So I think avoiding that assumption is healthy,
[00:30:02.550]although it's always good to
[00:30:03.870]keep in the back of your mind that,
[00:30:06.330]hey, if they're providing that,
[00:30:08.130]we should probably find out
[00:30:09.150]how we can collaborate with them.
[00:30:11.730]And I would say you should assume this,
[00:30:14.220]that you should offer and provide training.
[00:30:16.800]Now, it could be that when you...
[00:30:19.140]Let's say you bring on a new BCBA into your district,
[00:30:24.660]I would assign them to a mentor
[00:30:26.670]and make sure that they were trained on what school means.
[00:30:30.420]Because if they're coming from a clinic,
[00:30:32.580]they're probably not going to be as well versed
[00:30:35.310]in anything that I think we take for granted
[00:30:38.100]as special educators.
[00:30:39.540]So that would also include though your district staff
[00:30:43.110]who may have no idea how to collaborate
[00:30:46.110]with an outside person.
[00:30:47.310]In my first training, I shared the stories about,
[00:30:50.850]a couple of stories about me and my first attempts
[00:30:53.730]to work with BCBAs,
[00:30:55.347]and it wasn't my best work at all.
[00:30:58.650]And what I will say to that is
[00:31:00.510]I could have used some training and mentoring
[00:31:02.910]and now I make sure that people know,
[00:31:05.040]and you should provide that.
[00:31:06.750]I would assume that the family needs coaching
[00:31:10.860]in what ABA is, what it looks like in the school setting,
[00:31:15.690]and what outside providers can and can't do.
[00:31:18.570]And to some degree, that goes back to
[00:31:21.210]my recommendation around make sure that you have
[00:31:23.580]your policies and procedures in place.
[00:31:26.700]Families often don't know.
[00:31:28.350]They don't know that they can't just bring their person in
[00:31:31.620]or ask for them to come in during the school day.
[00:31:34.350]And I think it's only fair for us to have
[00:31:36.540]that discussion with them.
[00:31:38.310]And I would also say assume that part of your work
[00:31:41.040]is going to be establishing goals,
[00:31:43.260]establishing timelines, and establishing parameters.
[00:31:46.230]And so for the BCBAs in the room,
[00:31:48.300]we call these antecedent interventions.
[00:31:50.970]We wanna make sure that we set people up for success
[00:31:55.680]before we have problems.
[00:31:57.510]So that's the general advice that I would give
[00:32:00.240]to all of you that are working in schools.
[00:32:02.670]Now I want to model a problem solving process,
[00:32:07.290]and it looks a little something like this.
[00:32:09.780]So this is just the way that I have encouraged districts
[00:32:12.840]to think about how they're going to collaborate with
[00:32:16.650]and potentially message about ABA
[00:32:19.800]and utilize ABA in some way.
[00:32:22.710]So you can see this as a continuum,
[00:32:24.450]and I'm going to discuss each of these,
[00:32:25.950]but let me just really quickly go over this.
[00:32:27.990]So the idea here is that there's some ask, whatever it is,
[00:32:32.700]the ask could be anything,
[00:32:34.860]and we need to have a way to respond.
[00:32:37.740]And the way that you respond to that
[00:32:39.240]is to have an IEP meeting.
[00:32:41.130]Everything should be done in the context of an IEP meeting.
[00:32:44.910]I have heard stories of people saying,
[00:32:46.477]"I asked and I just got a no on email."
[00:32:49.320]That's really setting the district up for
[00:32:52.740]problems later that are avoidable
[00:32:55.200]by meeting with the team
[00:32:57.630]and having a procedure to discuss things.
[00:33:01.320]So what are we discussing?
[00:33:02.700]We're discussing what the ask is.
[00:33:04.800]We're discussing what are the potential barriers.
[00:33:07.830]Is there a way that this ask might be impeding FAPE?
[00:33:12.900]One thing that's not here but I think is assumed is
[00:33:15.570]how could we benefit from this?
[00:33:17.190]What could go well for the team and for the child?
[00:33:21.690]And to that end, we need to engage in some planning.
[00:33:24.060]So what might this look like?
[00:33:26.100]And set some parameters.
[00:33:27.660]Parameters can be anything from what
[00:33:29.910]someone can do or not do,
[00:33:32.070]how long, where, and goals.
[00:33:36.869]What do we see as a team coming from this?
[00:33:39.990]And I think the lack of setting goals
[00:33:42.360]is one of the areas where people get really, really stuck.
[00:33:45.960]And then we need to continue meeting
[00:33:47.820]and we need to continue talking to each other.
[00:33:50.340]So I think those are some of the things
[00:33:52.620]that I would advocate are appropriate in this situation.
[00:33:56.940]So here's this first scenario.
[00:33:58.230]So I'm gonna start out with an easy one.
[00:34:00.900]And I'm not really a screen reader,
[00:34:03.000]but I'm going to for this.
[00:34:04.080]So a family of a six-year-old with autism
[00:34:07.260]ask the district to allow their BCBA and their RBTs,
[00:34:10.220]so these are outside clinical people,
[00:34:12.360]to observe once per week to obtain data.
[00:34:15.330]Per the parent, this is for the purpose
[00:34:17.370]of assessing generalization and maintenance of skills
[00:34:20.460]taught in the home and in the clinic.
[00:34:23.130]So we have to think about how do we proceed with this.
[00:34:26.370]This is a very, very common scenario
[00:34:29.730]that gets asked of districts all the time
[00:34:32.190]by families that are accessing outside services.
[00:34:35.940]So what I wanna do, I'm actually going to leave
[00:34:39.360]my beautiful screen sharing for just a minute,
[00:34:42.030]and then go back in.
[00:34:43.740]I am going to
[00:34:47.040]model the use of this.
[00:34:48.900]So let's go ahead, and I see that there's a chat.
[00:34:52.110]Oh, hi Matt, good to see you.
[00:34:57.510]I'm gonna close the chat now and sorry for that,
[00:34:59.790]but there's a wonderful person in this class.
[00:35:02.190]So welcome.
[00:35:03.780]Okay, so we have this scenario.
[00:35:06.420]There's a six-year-old in the middle of all this
[00:35:09.180]with an outside agency and the school.
[00:35:11.940]The agency wants to come in and take data.
[00:35:15.090]How do you proceed?
[00:35:16.950]Well, let's go ahead and think about
[00:35:18.960]what we're talking about.
[00:35:19.920]What is the ask?
[00:35:21.270]So the thing that we have to grapple with is
[00:35:24.600]family wants BCBA to come in to observe
[00:35:31.260]the solution is meet in all situations as a team.
[00:35:37.620]So when we meet with the team,
[00:35:39.480]we're going to go back to what's the ask.
[00:35:43.320]What is that?
[00:35:44.490]And then the next thing that we're going to do,
[00:35:46.650]and I realize that I'm summarizing what could take an hour.
[00:35:50.250]But for time's sake, I'm just modeling for you.
[00:35:53.610]Potential barriers, what's the influence on FAPE?
[00:35:58.020]Well, a potential barrier that I see
[00:36:01.050]because I can't have interaction with you
[00:36:03.510]is confidentiality.
[00:36:05.730]That's one.
[00:36:06.930]The next one is,
[00:36:09.420]what if the BCBA and the RBT
[00:36:14.100]don't understand the school setting
[00:36:16.590]and then they go back to the family and say,
[00:36:20.227]"Oh no, something is wrong"?
[00:36:22.860]So another barrier might be information
[00:36:27.630]given to the family and many others.
[00:36:31.050]So then as you can see,
[00:36:33.960]the solution is just to go down the list itself
[00:36:38.130]and to work our way into planning.
[00:36:41.640]So let's say, okay, we're going to agree.
[00:36:44.070]We recognize that
[00:36:46.620]we can get over the barrier of confidentiality
[00:36:48.960]by discussing with the family and the BCBA and RBT
[00:36:53.340]who they can look at,
[00:36:55.020]that they can't take video or take photographs,
[00:36:58.860]and they can't ask questions,
[00:37:00.300]all the things that we're going to do.
[00:37:02.460]And then to make sure that we are engaging in the planning,
[00:37:06.360]what is the planning going to be?
[00:37:08.220]Could be anything from when it will start,
[00:37:12.720]frequency of this.
[00:37:14.910]We can go on and on.
[00:37:16.560]And then our parameters and goals.
[00:37:18.630]So parameters is information sharing,
[00:37:23.730]data collection for generalization.
[00:37:26.970]One thing I would wanna see as an administrator on this team
[00:37:30.390]is how is that information going to be used both ways.
[00:37:34.470]So I would like to see the treatment plan
[00:37:37.200]to know whether or not there's something
[00:37:38.730]that this IEP team needs or could use,
[00:37:42.180]and that's where we continue to meet.
[00:37:44.250]So we're going to do information sharing,
[00:37:46.740]data review, and planning.
[00:37:49.860]So that's the problem solving process in a nutshell,
[00:37:54.030]using a very, very easy case to start.
[00:37:58.110]So I'm going to go ahead and go from the current slide,
[00:38:01.980]and we'll get back into this.
[00:38:03.810]So this is just an example for you
[00:38:06.480]of what that might look like.
[00:38:08.100]Here's some things you might wanna think about
[00:38:09.780]in that scenario.
[00:38:11.310]In this particular situation,
[00:38:13.830]the team is not trying to provide services in school,
[00:38:16.890]but that's something we have to make sure
[00:38:19.050]at the get go that we ask.
[00:38:21.300]The second one is knowing what they are doing,
[00:38:24.540]that they're just trying to collect data for generalization.
[00:38:27.090]So when we teach skills that the holy grail
[00:38:31.530]is that these skills will be able to work in
[00:38:35.310]multiple settings with multiple people
[00:38:38.490]and even novel situations
[00:38:40.560]and over time what we call maintenance.
[00:38:43.290]So this is not an an unreasonable ask.
[00:38:46.440]It's just knowing what it is.
[00:38:48.180]So again, the parameters for this could be timing,
[00:38:52.140]so when.
[00:38:53.250]how long?
[00:38:54.480]Are we talking about an hour?
[00:38:55.710]Are we talking about six hours?
[00:38:58.110]There's this phenomena that happens with observers.
[00:39:03.330]So when you have someone come in,
[00:39:05.100]it could be the nicest person in the world,
[00:39:07.560]but it's stressful.
[00:39:08.820]So if we've got this person in there,
[00:39:10.890]even if they're just observing Johnny,
[00:39:13.620]you feel like you are on stage,
[00:39:15.750]and that is impact on the team.
[00:39:18.630]So thinking about duration is important.
[00:39:21.390]Confidentiality agreement,
[00:39:22.890]I would make sure that your district has that in place.
[00:39:26.610]And also that it is clearly discussed
[00:39:29.220]that there will be no interference
[00:39:31.110]with the student or other students.
[00:39:32.790]So if the BCBA or RBT is in the room,
[00:39:36.930]they shouldn't be prompting or redirecting that student.
[00:39:40.680]And if it's going to be problematic,
[00:39:42.450]we need to talk about what would that observation look like?
[00:39:45.000]Do they need to be in another room
[00:39:47.520]and watch through the window?
[00:39:49.620]I bet if I pulled everyone in here,
[00:39:51.690]we've all done that in some way or another
[00:39:53.730]in order not to have observer effects.
[00:39:56.520]And we should agree upon the number of visits.
[00:39:59.670]So all done within the context of the IEP meeting.
[00:40:03.840]And then of course we're going to send prior written notice
[00:40:06.480]to make sure that everyone is clear and we've documented it.
[00:40:11.160]Let's look at another case.
[00:40:12.450]So this scenario here.
[00:40:14.700]the district is serving a student
[00:40:17.370]who is engaging in high rates of self-injury and aggression
[00:40:22.080]toward others as well as property.
[00:40:24.810]While the staff in the school
[00:40:25.830]are trained in special education
[00:40:28.110]and general behavior supports,
[00:40:29.940]they're not trained in specific supports
[00:40:31.800]for such complex behaviors.
[00:40:33.420]There's no BCBA available to serve the student
[00:40:35.970]within the school staff or district.
[00:40:38.220]Situation's not getting any better.
[00:40:39.930]People are getting hurt.
[00:40:41.250]Sound familiar?
[00:40:42.210]This is a very familiar scenario,
[00:40:44.040]at least here where I live.
[00:40:46.590]The student's family works with an outside agency
[00:40:49.590]who provides services after school.
[00:40:51.780]Staff have suggested that perhaps
[00:40:53.910]it is time to seek their help
[00:40:55.440]to support the student so he can access his IEP services.
[00:40:58.800]So how do you proceed?
[00:41:01.620]So again, we would apply that same problem solving process.
[00:41:05.670]And so for the sake of time,
[00:41:08.070]I'm not going to to get in here and draw it out,
[00:41:12.060]but we would go in and we would do this throughout
[00:41:16.320]to make sure that we were addressing it both proactively
[00:41:20.340]and responding as we should.
[00:41:23.490]Again, the team, including the family,
[00:41:27.510]needs to go through this process
[00:41:29.340]because the ultimate thing
[00:41:30.600]they really need to come up with is,
[00:41:32.610]are they providing a FAPE right now?
[00:41:35.070]And whether that's yes or no,
[00:41:37.260]that is a consideration that should be noted.
[00:41:40.350]And depending on the outcome of that,
[00:41:42.240]including going through the IEP and determining
[00:41:45.270]the effects of the behavior on access,
[00:41:48.570]the team might want to consider a couple of things.
[00:41:50.760]First of all, could they contract
[00:41:53.130]with an outside APA provider
[00:41:55.590]to provide the behavioral services?
[00:41:57.870]So we're not talking about providing educational services
[00:42:01.290]because, to be honest, that's not something
[00:42:03.870]that most of us are trained in.
[00:42:05.760]So could it be that we find someone
[00:42:08.820]that could work alongside
[00:42:10.440]the educational staff in the school,
[00:42:13.050]or is it possible that we provide ABA
[00:42:17.760]and provide that person in an educational setting
[00:42:21.990]such as clinic or non-public agency?
[00:42:25.080]With the second one,
[00:42:26.820]we absolutely have to think about a reevaluation
[00:42:30.810]because that is a significant change of placement,
[00:42:33.570]in fact, so is adding in an ABA provider as well.
[00:42:37.290]So either way, your district would need to make sure
[00:42:40.770]that they were reevaluating to determine
[00:42:43.560]what is it that the student needs,
[00:42:45.150]and then looking at, can we provide that?
[00:42:47.880]And if we can, do we contract and what does that look like?
[00:42:51.420]Now I noticed that there was a question
[00:42:52.860]in the chat or maybe a comment,
[00:42:54.510]so I just wanted to quickly grab that and see.
[00:42:58.740]So since we as a school district
[00:43:01.110]have a board of education policy related to people,
[00:43:03.990]including professionals visiting schools,
[00:43:05.790]would not see this as something
[00:43:07.050]that an IEP team would consider,
[00:43:09.270]Why would an ABA clinic person be any different?
[00:43:14.160]That's a really good point.
[00:43:15.390]If you already have that policy in place,
[00:43:18.840]and I knew that as perhaps the principal of the building
[00:43:22.920]or the program administrator.
[00:43:25.950]Guess what we would have to decide
[00:43:27.900]is whether or not that met the policy.
[00:43:31.290]And if it doesn't, then I think we have to say no.
[00:43:35.734]This is a policy and it's a policy that we have to follow.
[00:43:39.510]And so it's not always possible.
[00:43:41.100]However, I will present the flip side to this is
[00:43:45.750]there are reasons why a person might come in
[00:43:49.320]to make sure that what they're doing
[00:43:51.780]is generalizing or vice versa.
[00:43:54.990]So, that's probably beyond the scope
[00:43:57.930]of this limited time that I have,
[00:44:00.000]and I appreciate the question.
[00:44:01.230]I'd be happy to talk to you more about this offline,
[00:44:04.800]in my emails at the end.
[00:44:06.540]I know that that is a situation
[00:44:08.460]that you're facing, many of you.
[00:44:11.130]So I will move on, but thank you for that question.
[00:44:13.890]Here's another scenario,
[00:44:15.420]so I'll try to read this as quickly as I can.
[00:44:18.630]A parent has been sending her child to a clinic all day,
[00:44:22.230]five days a week since the pandemic restrictions began,
[00:44:25.800]Insurance has continued to pay the fees
[00:44:27.870]for full day services.
[00:44:29.130]The BCBA on the case has slowly started to suggest
[00:44:32.520]that perhaps it is time for the student to return to school.
[00:44:36.390]The district has maintained contact with the family
[00:44:39.600]and has continued to offer IEP services,
[00:44:42.000]which the parent declines.
[00:44:43.890]The student has been developing
[00:44:45.300]stronger social skills and language,
[00:44:47.220]but has limited communication partners
[00:44:49.140]and no access to academic instruction from a teacher.
[00:44:52.560]The parent reluctantly agrees to give it a try
[00:44:54.990]and the school team brings the student in with the ABA team.
[00:44:59.580]In school services start, but they start on the wrong foot.
[00:45:03.720]So I'll just put it out there like this.
[00:45:05.820]The teacher places a student in a separate room
[00:45:08.280]with the RBT from the clinic.
[00:45:10.320]The RBT runs programs,
[00:45:12.780]and this is a term that
[00:45:15.210]pretty much everyone as BCBN here can recognize.
[00:45:18.360]They're running these instructional programs
[00:45:21.030]and the teacher is working with other students.
[00:45:23.370]So you can already see how this situation
[00:45:26.280]has not started off on the right foot at all.
[00:45:29.880]The teacher does not provide any attention
[00:45:32.280]or services to the student
[00:45:33.810]other than to occasionally reprimand him
[00:45:36.330]when he is aggressive.
[00:45:37.950]The RBT begins to report
[00:45:39.570]that the student isn't receiving any services
[00:45:41.880]and that the teacher's classroom is a mess.
[00:45:44.970]The RBT communicates constantly with the parent.
[00:45:48.000]The teacher never does.
[00:45:49.770]Situation comes to a head when the mother tells the district
[00:45:52.380]that the teacher isn't following the treatment plan,
[00:45:55.650]and that the RBT is the only source of information.
[00:46:00.420]So in this situation, which is real,
[00:46:03.180]what's do we do about that?
[00:46:05.730]How do we proceed?
[00:46:07.950]So because we are looking at the provision
[00:46:11.370]of FAPE in this situation,
[00:46:13.380]we should go through this problem solving process
[00:46:17.190]and talk about what the ask is.
[00:46:19.650]So there are multiple asks here.
[00:46:21.840]meet with the IEP team and talk about what are the barriers
[00:46:25.620]that are influencing this child's FAPE.
[00:46:27.927]And in my opinion, a lot of things should have been done
[00:46:30.660]that weren't done.
[00:46:32.040]This planning that you see here in this process model
[00:46:35.820]really wasn't done.
[00:46:37.200]The student was simply just put in the school.
[00:46:39.510]So I don't fault anyone in this situation
[00:46:42.360]other than we have to think and plan very carefully
[00:46:45.960]when we are saying yes to something
[00:46:49.170]and what is it that we're saying yes to.
[00:46:51.930]So some thoughts on this.
[00:46:54.030]Where did things go wrong in the first place?
[00:46:56.940]There were some important steps
[00:46:58.440]that were missed in this process.
[00:47:00.000]So in this situation, what actually did happen
[00:47:04.110]is we had to bring the team together
[00:47:05.910]when we saw what was going on.
[00:47:08.280]Side note, the ABA team, the clinical team
[00:47:13.140]needed and received immediate training.
[00:47:15.930]And that training was,
[00:47:17.910]we don't do treatment plans in a school setting.
[00:47:21.150]That's not what we're there for.
[00:47:22.590]We are supposed to be there
[00:47:24.450]to help the team to implement the IEP.
[00:47:27.090]They'd never seen the IEP.
[00:47:28.650]They didn't know what was in the IEP.
[00:47:30.510]So again, this is where the team didn't come together
[00:47:34.590]and was not prepared to work together.
[00:47:37.410]Also, having the RBT communicate with the mom,
[00:47:41.880]that needed to stop right away.
[00:47:43.800]And the mom and the teacher had to figure out a way
[00:47:46.800]to communicate with each other.
[00:47:48.600]So you can imagine if you were the administrator,
[00:47:51.780]you had a lot of work to do to repair.
[00:47:54.570]Also, the parent didn't understand
[00:47:56.820]that the treatment plan wasn't
[00:47:58.890]going to be implemented in the school setting.
[00:48:01.260]The IEP was going to be implemented in the school setting.
[00:48:04.500]So in this case, what needed to happen and did
[00:48:07.020]is the team needed to get together, clarify what the ask is,
[00:48:11.040]and come up with a plan, including goals.
[00:48:13.470]What is the goal for having these staff in that setting?
[00:48:17.880]What is the goal for the student
[00:48:19.290]in terms of being able to integrate
[00:48:21.300]into that classroom setting?
[00:48:23.370]And then come up also with communication norms
[00:48:26.130]so that the teacher was not clear
[00:48:28.590]that she needed to communicate with the mom,
[00:48:31.290]and the mom was highly reinforced
[00:48:33.840]by having constant communication with the RBT.
[00:48:37.197]And so this is where we need to get together and say
[00:48:40.740]how is mom going to be informed every single day
[00:48:43.710]about what her child is doing.
[00:48:45.120]Child's nonverbal, by the way.
[00:48:46.440]They're not able to talk about how the day went.
[00:48:49.140]So what will that look like?
[00:48:51.750]And then the assertion needs to get out there
[00:48:54.330]that the IEP drives the program.
[00:48:56.700]The treatment plan never drives the program.
[00:49:00.180]And so the consultant that worked with the clinical team
[00:49:03.570]really had to do some education around that.
[00:49:06.270]And that's okay, these things happen.
[00:49:08.490]It's just important to recognize that
[00:49:11.010]not every team is going to come in
[00:49:13.590]trying to be ready to understand your setting.
[00:49:17.160]And then there certainly does need to be a system
[00:49:19.650]for increasing instructional access.
[00:49:21.510]You can imagine how confused that teacher was.
[00:49:24.780]They had no idea how to embed these services
[00:49:29.070]and bring them alongside.
[00:49:30.780]So of course she said, "Well fine,
[00:49:32.400]I'll just work over there because they're here."
[00:49:34.647]But that really was not the intent of this.
[00:49:37.980]And then lastly, training, ongoing training.
[00:49:41.820]What does the BCBA team, the ABA team do?
[00:49:45.600]The parent needs to know all of that.
[00:49:47.400]They need to understand what's happening in school
[00:49:50.250]and the team as well needs to understand this.
[00:49:52.500]So a lot of things needed to happen here
[00:49:55.440]in order to make this go smoothly.
[00:49:58.200]So the bottom line in this,
[00:49:59.787]and it feels like this timeframe always goes very quickly,
[00:50:03.180]but I wanna leave a little bit of time for questions.
[00:50:06.300]So aspects to consider
[00:50:08.910]when we are having ABA providers come in,
[00:50:12.990]whether hired or not,
[00:50:15.300]is that we have to provide a FAPE.
[00:50:16.770]That's the bottom line first.
[00:50:18.810]And we should assume everyone needs training,
[00:50:21.720]and that's from the parent to the IEP team
[00:50:24.840]to the ABA providers themselves.
[00:50:27.720]Everyone will need training in what is ABA,
[00:50:30.750]what is the purpose.
[00:50:32.400]All of these pieces need to fit together
[00:50:35.340]and there need to be some non-negotiables
[00:50:38.280]in terms of offering FAPE that, for example,
[00:50:41.730]academics are provided by a teacher
[00:50:44.250]or a paraprofessional who who is monitored by the teacher.
[00:50:48.480]And materials need to be designed by the teacher.
[00:50:52.080]There needs to be a problem solving process
[00:50:54.360]in every situation.
[00:50:55.710]If it's not the one I modeled,
[00:50:57.450]develop one on your own in order to keep FAPE at the center
[00:51:01.860]and figure out what the ask is and what your plans will be.
[00:51:05.340]I know that for the superintendents in the room and others,
[00:51:09.480]there's usually a policy,
[00:51:10.980]and I advocate for a case by case basis,
[00:51:13.950]which is hard when you're trying to say,
[00:51:16.207]"Here's our structure, here's our routines."
[00:51:18.870]But there are times where this can be of great benefit
[00:51:21.930]to the family and the relationship.
[00:51:24.450]It's also important to know when to draw the line.
[00:51:27.180]So in this situation that I just discussed with you,
[00:51:30.570]the line had to be drawn around
[00:51:32.460]communication with the mother
[00:51:34.020]or mother expecting that the treatment plan
[00:51:36.870]would be followed.
[00:51:37.703]And we needed to redirect the team to the IEP itself.
[00:51:42.690]And then also just knowing that ongoing
[00:51:45.960]shaping and growing of skills of all team members
[00:51:49.200]will be necessary.
[00:51:50.430]It's not a one-time deal.
[00:51:52.380]So these are the things I think
[00:51:53.640]as I'm thinking about having ABA in school
[00:51:57.210]that are incredibly important.
[00:51:59.160]And again, I would advocate that
[00:52:01.380]the work that a good ABA team can do can be very significant
[00:52:06.120]when it is planned and implemented correctly.
[00:52:09.330]So this is my contact information,
[00:52:12.180]I just wanna make sure that attendees
[00:52:13.950]know that this is in here so that
[00:52:16.140]you're not all relying too much
[00:52:19.380]on Annette and Megan to provide that.
[00:52:22.170]So if you wanna get in touch with me,
[00:52:24.270]there's my information.
[00:52:25.530]I will stop sharing now
[00:52:28.320]and open it up for questions or comments.
[00:52:49.998]So Annette or Megan, do you have any questions
[00:52:52.950]or has anyone communicated with you,
[00:52:55.140]anything that they're wanting to discuss?
[00:52:58.920]I don't see any yet,
[00:53:00.780]so I'm hoping that if we just pause,
[00:53:02.940]there'll be a little more conversation in the chat box.
[00:53:07.320]So- Sure.
[00:53:09.180]Yeah, I loved those scenarios
[00:53:11.010]and just the problem solving process that you went through.
[00:53:16.710]It looks like Martina has a question.
[00:53:23.400]Okay, let's start with that.
[00:53:26.010]If a medical provider deems ABA services medically necessary
[00:53:30.360]and the state, Colorado, has a house bill in place
[00:53:33.060]that states ABA services must be provided
[00:53:35.850]in the school setting as it is medically necessary,
[00:53:39.120]when those hours cannot be completed outside of school,
[00:53:41.850]does the IEP or treatment plan drive the student need?
[00:53:45.990]Well, to me it seems like Colorado has put
[00:53:49.530]the school district in a conundrum.
[00:53:52.710]So I apologize that you're in this situation.
[00:53:57.660]When you have a situation like that,
[00:53:59.940]what I think you need to do
[00:54:01.920]is to first of all say when a student is in school,
[00:54:05.490]what is the access issue?
[00:54:07.290]So when we're talking about providing a FAPE,
[00:54:10.350]it is because something is a barrier to access,
[00:54:13.080]whether that's behavior, or academic needs,
[00:54:16.710]or fine motor, or whatever it is.
[00:54:19.260]So if there is,
[00:54:21.560]if if ABA services are contracted with an outside agency,
[00:54:26.760]then perhaps that treatment plan could be a part of it.
[00:54:29.940]What I can't figure out from your comment...
[00:54:33.570]Is it Martina?
[00:54:34.560]Is does this mean that the school setting
[00:54:38.790]is responsible for paying for these
[00:54:41.340]or that the insurance company is paying for this?
[00:54:45.600]Do you happen to know that?
[00:54:53.070]No, we are not, the insurance.
[00:54:54.600]Okay.
[00:54:55.433]So in that case, what I would suggest is that
[00:54:59.310]you look at the treatment plan, look at the IEP,
[00:55:03.360]and figure out what components of this plan,
[00:55:07.530]if provided alongside the educational services,
[00:55:13.260]are likely to encourage access and decrease barriers.
[00:55:18.240]I would never, ever think it's wise
[00:55:21.420]to have a treatment plan supersede
[00:55:24.300]the FAPE that's being offered in IEP.
[00:55:26.850]I just wouldn't.
[00:55:27.750]And so I'd have to look into that more,
[00:55:30.810]but that's my first answer.
[00:55:33.030]Deirdre, what I was referring to in training
[00:55:37.410]is through IRIS, the Vanderbilt IRIS modules,
[00:55:41.340]and I can provide more to you later on that.
[00:55:45.270]And yes, that was it.
[00:55:47.220]Okay, so thank you.
[00:55:48.840]That's a really good question
[00:55:50.010]and I was not aware that Colorado was there,
[00:55:53.250]and I'm in the Ninth Circuit as well.
[00:55:54.900]So I'll have to find out now how that may or may not apply
[00:55:57.990]in Washington State.
[00:55:59.460]Any other questions or comments?
[00:56:10.630]Okay, Carrie, in addition to educating...
[00:56:13.260]Woo, okay, let me go (laughs) up a little bit here.
[00:56:16.920]Let me see.
[00:56:21.210]In addition to educating families about how ABA
[00:56:23.730]is embedded in the school day,
[00:56:24.810]do you have any strategies
[00:56:25.800]for getting students back into school,
[00:56:27.450]decreasing time out of school day for clinical ABA?
[00:56:30.840]Oh gosh, that would be in and of itself
[00:56:33.060]a great webinar to have just on that.
[00:56:36.168]And I think one of the ways that we start to do that
[00:56:39.270]is to help families, first of all, to know
[00:56:42.210]that school is a natural environment for kids.
[00:56:44.550]And that's a message that also needs to be sent
[00:56:47.100]by the clinics.
[00:56:48.720]And I think that we have to start there.
[00:56:50.820]We have to come to agreement
[00:56:52.800]on what is the natural environment for skill learning
[00:56:57.660]and for skill generalization and maintenance.
[00:57:00.360]So that's one thing.
[00:57:01.890]I think getting together and setting goals
[00:57:04.860]around how much time we're going to start with.
[00:57:07.560]And then could we fade that time
[00:57:10.020]by at first having providers maybe come in the school
[00:57:13.830]to observe and then have crosstalk?
[00:57:16.800]Those are always.
[00:57:18.882]But again, Carrie, my contact info is at the end of this,
[00:57:22.200]and I would be so happy to talk to you more about
[00:57:24.510]some strategies around that.
[00:57:26.610]So please do reach me if you need to.
[00:57:30.060]Okay, so Gina, as a school IEP team member,
[00:57:33.450]but not a case manager,
[00:57:34.650]how do we recommend these planning sessions?
[00:57:36.720]What's been happening in our are
[00:57:37.953]a is the community-based ABA clinic is recommending
[00:57:40.360]30 to 40 hours of ABA
[00:57:42.480]and then just go to kindergarten, get an IEP.
[00:57:45.390]So what happens is we have these students
[00:57:46.740]who have never been in a school setting with full-time ABA
[00:57:50.160]showing up to kindergarten without any notice of needs.
[00:57:54.810]And notice of needs meaning that they're just showing up
[00:57:57.420]but no one has said that they have a disability
[00:57:59.910]or that they have these behaviors?
[00:58:04.260]Okay, so to me, that is training around Child Find
[00:58:08.850]and understanding the role of special education preschool.
[00:58:13.740]Gina, to me, that's a side conversation
[00:58:16.500]around helping the clinics to understand
[00:58:18.630]the role that we have
[00:58:20.010]in providing those part C services.
[00:58:22.140]So if you want contact, me and we can talk through
[00:58:25.620]a good answer for that.
[00:58:33.040]Okay, so I wanna say thank you again for coming,
[00:58:36.930]and there are two more sessions.
[00:58:38.790]I'll let Annette take over for that part.
[00:58:41.070]Was really wonderful to have you here.

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Applied Behavior Analysis Therapy in Schools for School Administrators and School Staff Part II

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