ABA in Schools: It's a Different World Part 1

Vanessa Tucker Author

04/11/2024 Added

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[00:00:06.960]Well, thank you very much and it's good to see such a mix.
[00:00:10.080]I am coming to you from Arizona,
[00:00:12.600]which is not where I normally live,
[00:00:14.820]and so we're gonna roll with it no matter what happens
[00:00:19.590]and hopefully there'll be no big snafus
[00:00:22.710]with internet or sound or anything.
[00:00:25.320]So thank you very much again
[00:00:26.640]for the Autism Spectrum Disorders Network for hosting me.
[00:00:30.840]My name is Vanessa and I am very pleased to talk about
[00:00:34.920]a subject that is so near and dear to my heart.
[00:00:37.650]So again, thank you for being here.
[00:00:39.720]And you will have handouts that Annette can get to you.
[00:00:43.770]So we went through the introductions.
[00:00:48.060]So my name is Vanessa Tucker.
[00:00:49.590]I'm from Washington State.
[00:00:51.720]I am an associate professor of special education
[00:00:56.100]in the state of Washington at Pacific Lutheran University
[00:00:58.800]and I also teach for a couple other places too,
[00:01:01.200]just for fun in their ABA programs.
[00:01:04.200]I have been very interested in the topic
[00:01:07.290]of school-based ABA for years.
[00:01:09.930]So this is one of my main areas.
[00:01:11.850]My scholarly interest is that.
[00:01:14.190]And one of the things that I'm always very aware of
[00:01:18.180]ever since becoming a BCBA or even before that
[00:01:22.380]is the extent to which these role differences
[00:01:25.350]can lead to some interesting conversations.
[00:01:27.870]So that will really be the majority
[00:01:29.880]of what we cover these next two sessions.
[00:01:33.450]I'll talk a little bit about what the obligations are
[00:01:36.330]for school and how that might differ from
[00:01:38.880]and certainly does differ from working in a clinic.
[00:01:41.010]I have done both and I do both now.
[00:01:44.160]And I'll talk a little bit about the goals
[00:01:45.930]for the second session, just to let you understand
[00:01:48.870]what we're doing today and how that then works us
[00:01:52.500]into our discussion next week,
[00:01:54.300]which is much more about problem solving
[00:01:56.790]and looking at how we collaborate together
[00:01:59.820]despite maybe some of these fundamental differences.
[00:02:02.970]So welcome.
[00:02:04.140]Now this next slide is just to say,
[00:02:09.420]I'm always looking for how things are different
[00:02:12.540]and how they're relatable.
[00:02:13.590]And I just got back from Texas.
[00:02:15.090]We just visited family over there
[00:02:17.748]and I went for a walk and I saw this.
[00:02:19.950]This is something that you would not see
[00:02:21.900]in Washington State.
[00:02:23.460]It's just never gonna happen.
[00:02:25.170]And it's a flood gauge.
[00:02:26.310]Now I'm about five foot two, so I could stand next to it
[00:02:29.940]and just imagine what it would be like
[00:02:32.490]to have that much water come up
[00:02:35.642]and completely wash out the road.
[00:02:38.490]Apparently that's the thing there.
[00:02:39.990]So I highlight that because we're going to highlight
[00:02:43.860]some differences and similarities between
[00:02:46.530]these two cultures of school and clinic
[00:02:48.960]where it might get a little bit fuzzy or confusing
[00:02:51.780]as you're trying to practice and serving students.
[00:02:55.470]So first thing is if you have a question,
[00:02:59.160]go ahead and put it in the Q&A box
[00:03:00.870]and I'll try to make sure that Annette can monitor those
[00:03:04.020]and then I can answer them as I go.
[00:03:06.150]I'll also make sure that you get my email,
[00:03:08.040]so if you wanna follow up or you wanna make sure
[00:03:10.500]I cover something next week, that you can get that in
[00:03:13.590]so that you're getting exactly what you need.
[00:03:16.140]So when it comes to role differences, I kind of liken it to,
[00:03:21.030]oh my goodness, we're not in Kansas anymore.
[00:03:24.390]So when I think about what it's like for
[00:03:27.660]a clinic-based person to transition into schools,
[00:03:30.540]it can be like going to Oz.
[00:03:33.060]And I'm hoping that by the end of this, you'll say,
[00:03:35.647]"Yeah, that is kind of what it feels like.
[00:03:37.440]And gosh, I was wondering what that term meant
[00:03:39.480]or why they do these things."
[00:03:40.977]And so in this next hour, my goal is to really
[00:03:44.640]go through them and talk about the why
[00:03:47.460]because I should also have said that
[00:03:49.320]I have been working in schools ever since 1995.
[00:03:52.440]So a lot has changed, a lot has not.
[00:03:55.350]I always tell my husband I could go anywhere in the US
[00:03:58.620]and go to any school and it's the same.
[00:04:00.450]When you walk in the door, it's the same.
[00:04:02.280]Pretty much the same thing.
[00:04:04.740]Rinse, repeat.
[00:04:06.060]But one of the things I wanna do is pull the curtain back
[00:04:09.540]like in Oz and help you to understand,
[00:04:11.790]well what is really going on here and what is driving
[00:04:15.150]the practices that I'm seeing?
[00:04:17.220]So let's go ahead and start with a case.
[00:04:20.310]Again, not really a screen reader,
[00:04:21.900]but I will do it for this particular one.
[00:04:24.480]You are a clinic BCBA.
[00:04:26.040]So imagine those would be school people
[00:04:27.780]that you are in clinic that primarily handles
[00:04:30.960]complex cases in schools.
[00:04:33.180]Another BCBA before you has left
[00:04:35.190]and you inherit their caseload.
[00:04:37.170]One of them is a school case
[00:04:38.490]where there is a full-time RBT at six hours a day
[00:04:41.490]in the classroom supporting a five-year-old
[00:04:43.620]who demonstrates interfering behaviors.
[00:04:46.200]This ABA service is being paid for by insurance.
[00:04:49.680]You begin a fade plan by reducing the RBT
[00:04:52.230]to three hours a day and putting him
[00:04:55.500]on another student for the other three.
[00:04:57.930]You then learned that the team has no FBA or a BIP
[00:05:02.310]and has been using the clinic's treatment plan.
[00:05:05.010]Upon learning this, you ask the school team
[00:05:07.110]to draft their own FBA and PBIP for this child's IEP.
[00:05:10.920]During a recent meeting where your clinic's director
[00:05:13.200]of school services suggests to the school team
[00:05:16.380]that our services should move to a consult model,
[00:05:18.750]you are met with considerable criticism.
[00:05:21.270]The psychologist states the child needs this
[00:05:23.520]and that the clinic needs to work with the school
[00:05:25.350]to make sure that he's getting his services.
[00:05:27.780]Director states, it's clinic director,
[00:05:30.180]that the school needs to provide a FAPE and should not rely
[00:05:33.690]on insurance-based services to provide them.
[00:05:36.510]So my wondering is what are your thoughts on this?
[00:05:40.500]So we'll take a minute, I'm gonna stop for just a second
[00:05:42.690]and ask you in the chat.
[00:05:44.430]What are your thoughts on that scenario?
[00:05:45.960]What's going on here?
[00:05:47.160]What might be going wrong?
[00:05:53.700]If you can type anything you want in the chat,
[00:05:56.520]what would you think is going on?
[00:06:06.760]Okay, school's not understanding the role of the RBT,
[00:06:10.200]communication outside BCBA role, ease in treatment plan,
[00:06:14.160]the school setting, there may be litigation concerns,
[00:06:17.940]billing for more than just one client.
[00:06:20.550]Nope, they're only billing for that client.
[00:06:23.460]I can answer that right away 'cause all the cases
[00:06:27.120]that I put in here are ones that are very current.
[00:06:32.670]Okay, but the RBT is being used
[00:06:35.640]for more than just one client?
[00:06:36.930]No, just the one.
[00:06:37.980]Six hours a day for just the one.
[00:06:40.290]No FBA, no behavior plan.
[00:06:43.260]Okay.
[00:06:44.160]School needs to conduct
[00:06:44.993]their own assessment, provide services.
[00:06:46.560]Good, so there's some good connection to some of the issues
[00:06:51.360]and there are many going on with this case.
[00:06:54.600]So I'm going to go ahead and share my screen again.
[00:06:58.350]And you identified all of them,
[00:07:01.560]the primary issues that are going on here,
[00:07:04.770]and this is a case that is right now is current
[00:07:10.671]and happening and is an example of
[00:07:12.540]where things can go wrong.
[00:07:14.910]So I just want you to hold that case there for a minute
[00:07:19.897]and to know, yes, you correctly identified a problem
[00:07:22.440]such as using the insurance-based treatment plan,
[00:07:26.280]no FBA or behavior intervention plan.
[00:07:29.580]All of those things are examples of
[00:07:33.510]where we need to kind of peel back the curtain
[00:07:36.570]and figure out what our next steps should be.
[00:07:39.510]But I want to take now a different turn just briefly
[00:07:43.500]and talk about some of the different roles
[00:07:46.710]and maybe how we got there in the first place.
[00:07:49.440]So I wanna start over on the right hand side
[00:07:52.590]with the clinic, and to do that,
[00:07:55.320]I'm going to use a little highlighter if I can
[00:07:58.230]and just show, so in the clinic,
[00:08:00.510]the licensed provider, i.e., the BCBA,
[00:08:03.660]is usually the leader of a very small team.
[00:08:07.050]So it's normally the BCBA, maybe the behavior technician,
[00:08:11.760]the parent and the client
[00:08:13.920]or sometimes the patient themselves.
[00:08:16.530]And then their role really is to do the assessment,
[00:08:20.190]write the treatment plan, create the program plan,
[00:08:24.180]use delegation to train that behavior tech,
[00:08:28.020]look at that ongoing data collection, provide the analysis,
[00:08:32.490]ongoing supervision, which could look anything from, okay,
[00:08:36.510]based on this, let's do this now or let me demonstrate
[00:08:39.660]how to do this particular strategy or technique.
[00:08:42.870]And then certainly part of this
[00:08:44.700]with most insurance companies anyway is parent training
[00:08:47.820]and coaching, which is just almost sort of a given
[00:08:50.490]that parent training is included in these plans.
[00:08:54.120]And then lastly, and sometimes
[00:08:56.310]consultation for other settings.
[00:08:58.650]So when we think about what might have happened
[00:09:03.240]besides the obvious things I mentioned,
[00:09:05.340]one way this could have gone better is if
[00:09:08.790]the insurance-based ABA service was more about consultation
[00:09:14.010]and training those who worked with this little guide
[00:09:17.580]in order to basically provide antecedent-based interventions
[00:09:22.470]that probably would've taken care of a lot
[00:09:24.720]of the interfering behaviors that he does have.
[00:09:27.240]So I want to juxtapose that to
[00:09:30.090]the school-based clinician.
[00:09:32.610]So we have the clinic-based person
[00:09:35.550]with a very small team, but then we have
[00:09:38.580]what's possible in a school setting.
[00:09:40.440]And I want you to know that this is not an exhaustive list.
[00:09:43.500]So I haven't even gotten into where
[00:09:46.590]a clinic-based person might fit in.
[00:09:48.630]That we'll do next week when we talk about
[00:09:50.520]how to collaborate and work through barriers.
[00:09:52.560]But assume for now that when you're in a school setting,
[00:09:56.220]these are all things that are possible.
[00:09:58.080]So the first one would be to be an IEP team member.
[00:10:01.500]In other words, there is a team of people that are part
[00:10:05.700]of this child's individualized education plan
[00:10:09.270]and you are a member of that team.
[00:10:12.030]And in addition, you may very well be a service provider.
[00:10:15.500]In other words, you could be someone
[00:10:17.910]that is providing direct service or you'd be someone
[00:10:20.850]that is supervising somebody else in that setting.
[00:10:24.720]You might also be what's called a behavior specialist.
[00:10:27.450]So some districts are using BCBAs like us
[00:10:31.080]to be a general, I guess for lack of a better word,
[00:10:34.860]a certificated person who provides behavior coaching,
[00:10:39.840]behavior intervention and training
[00:10:43.170]to a wide variety of students.
[00:10:45.930]It could also be that you are supporting
[00:10:49.680]certain certificated teachers.
[00:10:51.450]And I want you to notice this term,
[00:10:53.010]I'm gonna talk about it again later, cert in charge.
[00:10:56.550]So there's a big difference in the school setting
[00:10:58.860]in terms of hierarchy and I'm actually gonna
[00:11:01.020]talk about that in a few minutes as well.
[00:11:03.390]And in the school role, we are not the boss.
[00:11:06.870]In most cases it would be incredibly rare for us
[00:11:09.750]to have that clinic-based scenario where it's you
[00:11:14.160]and then the BT and then the client
[00:11:17.490]working alongside the family.
[00:11:19.170]It's very much more about how am I supporting this student
[00:11:23.460]who is on someone else's caseload.
[00:11:27.270]And then of course also you might be asked
[00:11:29.400]to supervise behavior technicians
[00:11:31.560]or engage in tiered interventions.
[00:11:34.137]And what I mean by that is anything from tier one
[00:11:38.250]where maybe you're helping out a classroom
[00:11:41.100]to devise classroom management strategies
[00:11:44.340]or group-based behavior contingencies
[00:11:47.400]or any other tier one problem, or maybe tier two
[00:11:53.040]you're providing a very rapid response,
[00:11:57.600]but short-term intervention for a group of students
[00:12:00.600]that require some type of instruction around an issue.
[00:12:04.740]Or it could be that you're tier three
[00:12:07.170]providing interventions on a much more
[00:12:10.260]individualized, intensive and enduring basis.
[00:12:13.770]Unfortunately, most of the time, I'll just say this now
[00:12:16.500]as commentary, BCBAs and school systems
[00:12:19.800]end up being tier three providers and it's unfortunate.
[00:12:23.220]I wish that we could do more with the other tiers.
[00:12:25.230]We might prevent some of the things that happen.
[00:12:27.690]And I think I'm preaching to the choir at that tier three.
[00:12:31.650]You might also be what's called a related service provider.
[00:12:35.040]And so in Washington State, that is the case.
[00:12:37.500]We can be on an IEP as BCBAs providing a service
[00:12:42.390]to students that helps them to benefit
[00:12:45.540]from special education to access it.
[00:12:48.450]You may be coaching a team on how to write,
[00:12:52.950]how to create an FBA or behavior plan.
[00:12:56.460]It's always a little unfortunate to me to see
[00:12:59.460]that either the school psychologist is writing the plan
[00:13:02.310]or the BCBA is writing the plan.
[00:13:04.830]In my opinion, what the research would say is this needs
[00:13:08.730]to be much more of a team effort together
[00:13:11.700]in order for this to be durable.
[00:13:14.010]In other words, it's something that's socially valid
[00:13:16.980]that other people will engage in
[00:13:19.440]even when you're not around.
[00:13:21.120]And then the other thing to remember is that
[00:13:23.520]when we're in schools, we're not the apex person.
[00:13:26.520]We're working alongside other people and school's got
[00:13:30.240]a lot of different contingencies than the clinic does.
[00:13:33.840]So with that in mind, let me go ahead and check the chat.
[00:13:37.980]Yes, let us help earlier, Jessica,
[00:13:40.110]I could not agree with you more.
[00:13:42.090]I would love to be in that position
[00:13:43.740]to help earlier to prevent those.
[00:13:46.230]So here's another scenario to think about.
[00:13:49.650]Your clinic has assigned you to a contracted school case.
[00:13:53.400]Okay, so in this case, you are working for a clinic,
[00:13:55.500]you're not working for the school.
[00:13:56.930]In this case, there will be a clinic RBT
[00:13:58.890]who will provide behavior support services
[00:14:00.960]to a student in a self-contained classroom.
[00:14:03.510]What I mean by that is a very specialized setting
[00:14:07.230]with one cert and maybe several paras
[00:14:09.510]and a very small class size.
[00:14:11.610]This student is complex with challenging behaviors
[00:14:14.190]that include aggression and elopement.
[00:14:16.410]You meet the teacher that morning
[00:14:18.180]who has 12 students on her caseload
[00:14:20.010]and five full-time paras, which that's a lot
[00:14:22.890]of people already, two of whom are one-to-ones.
[00:14:26.130]The RBT is to work alongside one of these paraprofessionals.
[00:14:30.390]For the next four weeks, you communicate primarily
[00:14:33.150]with the RBT and the parents about the student,
[00:14:36.780]their progress and programming which you design
[00:14:39.180]and are running through central reach.
[00:14:41.280]At the end of week five, the teacher is upset
[00:14:43.500]and calls a meeting.
[00:14:44.700]She states that you have not followed the proper protocol
[00:14:47.520]for meeting the IEP needs of the student.
[00:14:50.010]What happened?
[00:14:51.330]So what are some things you see that went wrong here?
[00:14:57.450]Put it in the chat.
[00:14:58.920]Anything goes.
[00:15:02.370]Teacher feels left out.
[00:15:08.160]What else?
[00:15:11.880]Lack of team, not collaborative, not schedule a meeting,
[00:15:15.330]didn't clarify roles, didn't team with school providers.
[00:15:18.810]Lack of understanding of how school teams operate.
[00:15:21.030]School, yep, lack of communication.
[00:15:23.760]You're hitting all of those big, big things.
[00:15:26.940]So this clinic-based person did
[00:15:31.020]what they would normally do in a clinic setting.
[00:15:34.980]They just carried it over in a basket
[00:15:37.350]to the school setting and implemented it there.
[00:15:44.403]And I see a lot of other comments
[00:15:45.360]around data collection, not involving.
[00:15:48.810]So what I see here is what you're seeing too is that
[00:15:52.470]we don't have clear goals, we don't have a clear plan
[00:15:55.470]and we have someone whose understanding
[00:15:58.620]is based upon their previous learning history.
[00:16:01.560]And that obviously is not how things work
[00:16:03.780]in a school setting.
[00:16:04.680]So this unfortunately is how this happens
[00:16:09.390]too often in a school setting.
[00:16:12.180]And then we end up having to basically unwind everything
[00:16:16.110]and do a lot of fix up work.
[00:16:18.900]So let's see, what is it that we need to consider?
[00:16:22.140]One of the things that I would say that all of you
[00:16:25.890]that are BCBAs and especially those of you
[00:16:29.070]that are clinic-based and might be providing
[00:16:31.140]some work in schools or even school-based people
[00:16:33.600]who are fairly new, is that what guides the clinic work
[00:16:38.580]and what guides the schoolwork are really very different.
[00:16:42.960]And I'm going to show you this in this form
[00:16:45.150]and then I'm going to show you this
[00:16:46.500]in a different way that's more visual.
[00:16:48.300]We all love our visuals in this field, right?
[00:16:50.460]So we start with school, the school system
[00:16:54.750]and the special education, and by the way,
[00:16:57.750]not every student you work with is going
[00:16:59.730]to be identified as a student with an IEP,
[00:17:02.790]but many of them will, is really guided
[00:17:06.630]by several things that you should know.
[00:17:09.240]So when you think about why are they doing those things,
[00:17:13.020]it is because we are required as school districts
[00:17:16.560]to implement what is outlined in IDEA
[00:17:20.940]or the Individuals with Disabilities Education Act.
[00:17:24.090]It's actually a little eye for improvement in there
[00:17:27.090]when it was slightly reauthorized
[00:17:29.820]but not really changed a whole lot.
[00:17:31.770]So IDEA is the federal law that guarantees the rights
[00:17:35.910]of students with disabilities to receive special education.
[00:17:39.630]504 covers people with disabilities and affords them
[00:17:44.430]reasonable accommodations based on disability.
[00:17:47.550]And of course, ADA is the Americans with Disabilities Act,
[00:17:51.150]and that guarantees access to the school setting.
[00:17:54.570]All of those things need to be considered.
[00:17:58.650]And there are a lot of policies and standards
[00:18:01.140]that really play into everything that you see.
[00:18:05.220]So for the outside observer,
[00:18:07.650]it might look a little confusing.
[00:18:10.230]Why are they doing things like talking about
[00:18:13.230]procedural safeguards or what is this heavy emphasis
[00:18:17.160]on accommodations really all about?
[00:18:18.870]I don't understand that.
[00:18:20.460]And so hopefully by the end of this two week session,
[00:18:23.970]you'll get a better idea.
[00:18:25.830]But the other things that are driving services
[00:18:28.080]in the school are the evaluations.
[00:18:31.200]The evaluation is not like a treatment plan.
[00:18:35.700]So I wanna make sure that
[00:18:36.750]we're very clearly separating them.
[00:18:39.180]They're like kissing cousins.
[00:18:40.830]But the difference is that the eval will tell us
[00:18:43.920]whether or not someone is eligible for special education
[00:18:48.060]and in what area they're eligible or areas
[00:18:52.260]and what their best category is.
[00:18:54.660]And to do that, really we have to demonstrate
[00:18:57.120]as an evaluation team that there is something
[00:19:00.240]called adverse educational impact.
[00:19:02.910]And if we demonstrate that, the eval will do that
[00:19:06.330]and we'll say the student needs services in behavior
[00:19:09.990]or adaptive skills or math or whatever it is.
[00:19:14.640]That drives that IEP.
[00:19:18.180]So the is the district's offer a FAPE
[00:19:22.620]to the student and their family.
[00:19:24.720]And that is our first code word, F-A-P-E, FAPE.
[00:19:30.570]So the IEP is the district's offer of FAPE
[00:19:35.040]and it's entirely based on that evaluation.
[00:19:38.640]We can't serve a student any more or less
[00:19:41.550]than what's in that eval.
[00:19:43.560]And the IEP team guides everything that is done.
[00:19:47.760]So the IEP team writes the goals, monitors the data,
[00:19:52.290]decides on the number of minutes and location
[00:19:55.500]and who's providing them and all the other things
[00:19:58.950]that are guaranteed for the student
[00:20:01.110]as part of that offer of FAPE, that IEP.
[00:20:05.070]But then along with that, we have these other layers
[00:20:08.040]of school policies, district policies,
[00:20:11.970]and along with that we have discussions around funding.
[00:20:15.090]We've got federal funds and state funds and local funds.
[00:20:19.470]Everything guides the services.
[00:20:21.780]Now, one thing I want to do is define FAPE
[00:20:25.478]so that you understand a little bit more about that.
[00:20:26.970]And I'll be doing that in a few minutes.
[00:20:28.560]So never fear some of these terms
[00:20:31.200]that you may have been dying to know about are coming.
[00:20:35.040]Let's talk about the clinic.
[00:20:36.690]So I want you to know that I am coming
[00:20:39.060]from the perspective of insurance funding.
[00:20:42.150]We know that clinic-based services
[00:20:44.370]could also be funded privately,
[00:20:46.980]they could be funded by a grant, they could be funded
[00:20:50.070]by the school district even.
[00:20:51.840]But primarily the same kind of form and function
[00:20:58.002]is recognizable just about everywhere.
[00:21:00.000]You have a functional assessment looking at
[00:21:03.180]what the student can and can't do
[00:21:05.790]and why ABA is necessary for that person.
[00:21:09.600]It is usually written by a BCBA.
[00:21:13.230]If it's written by a BCaBA, it is still overseen by a BCBA.
[00:21:18.870]And from that comes this treatment plan.
[00:21:22.170]And then treatment plan to me kind of looks like
[00:21:25.500]the combination of an evaluation
[00:21:27.300]and an IEP altogether, if I were to
[00:21:29.850]as a lay person, take a look at it.
[00:21:32.160]But it's not the same as the guarantee, the legal guarantee
[00:21:36.856]of FAPE that a district has to provide.
[00:21:39.690]The treatment plans are then implemented.
[00:21:44.340]There's graphing.
[00:21:45.270]So that's one beautiful thing about my field that I love.
[00:21:48.390]I love a good graph and I know that
[00:21:50.160]probably everybody else in here does as well.
[00:21:52.590]So we graph the data and we have to maintain a frequency
[00:21:59.130]of reassessment of sending the progress data
[00:22:02.910]to insurance companies, creating new authorizations
[00:22:06.720]and all the other stuff that comes along with that.
[00:22:09.360]And I realize that this is like taking the state of Texas.
[00:22:14.280]I was just there, right?
[00:22:15.390]And thinking about like Seattle, right?
[00:22:18.030]Like big and little.
[00:22:19.620]I'm not trying to minimize any of this,
[00:22:21.720]but these are just kind of thinking about
[00:22:23.700]what are the wheels that are driving the train here?
[00:22:27.510]So here's another way to look at this.
[00:22:29.580]When we think about school, we think about, all right,
[00:22:33.750]if I'm looking at what this student is getting
[00:22:36.990]or what this team is doing, it all starts
[00:22:40.410]with this evaluation right here.
[00:22:42.600]So the evaluation is what determines their eligibility,
[00:22:46.260]in what areas, what areas do they not qualify in?
[00:22:51.690]And from that, the team develops an IEP.
[00:22:54.660]Nestled within that is placement.
[00:22:56.790]So placement is erroneously thought of as minutes
[00:23:02.190]or location, but it's truly what services
[00:23:06.270]are provided, at what frequency and duration.
[00:23:09.750]So we think about intensity or dosage, who's going to do it,
[00:23:14.040]where might that be is kind of forth down the line.
[00:23:17.850]So the services are implemented as part of that IEP.
[00:23:21.780]And we take data.
[00:23:23.610]We might find that the data collection is different
[00:23:26.820]than what you would find in a clinic.
[00:23:29.220]And in a clinic, we're usually dealing with an N of one.
[00:23:32.010]That special ed teacher is collecting data
[00:23:34.800]on all 12 of those kids, or in general ed,
[00:23:37.830]we're taking data on everyone
[00:23:39.600]through a wide variety of processes.
[00:23:42.600]If we're talking about an individual student and IEP,
[00:23:45.900]as we go along, we need to reevaluate every three years
[00:23:50.430]and write a new IEP every year provided they still qualify.
[00:23:56.550]Of course, this again is very surface,
[00:23:59.250]but I think it helps if you're not familiar with,
[00:24:02.100]well why is it that we can't just do our own thing?
[00:24:04.740]It's because the eval and the IEP drive everything else
[00:24:08.190]that comes down the line.
[00:24:09.990]So some fundamental differences that I really want you
[00:24:13.200]to be thinking about that can sink our ship,
[00:24:17.520]I guess for lack of a better word, is that when it comes to
[00:24:21.600]what we do in schools, we're bound by federal laws.
[00:24:27.300]And there are some federal laws that apply
[00:24:30.750]in a clinic setting such as HIPAA for example.
[00:24:35.250]HIPAA is different in the school setting.
[00:24:37.800]It's actually FERPA.
[00:24:39.510]And that is something that, while I didn't put it on here,
[00:24:42.420]is important for you to know that once that
[00:24:45.840]that confidential information gets into the school setting,
[00:24:49.200]it is protected under the FERPA act versus HIPAA,
[00:24:54.240]which is outside the school setting in a medical setting.
[00:24:58.560]IDEA though, getting back to that, dictates that
[00:25:01.860]we do things in a certain way with certain timelines,
[00:25:06.600]with certain roles that have to be included
[00:25:09.510]in different parts of the process.
[00:25:12.720]So as you're thinking when you're sitting
[00:25:15.690]in an eval meeting around why is that person there?
[00:25:18.960]What are they doing?
[00:25:20.490]You're right to question those things.
[00:25:22.170]Those are all because of what IDEA mandates
[00:25:26.250]that we do in the school setting.
[00:25:28.574]But there's a couple more interesting things
[00:25:30.270]that I think are worth pointing out.
[00:25:32.220]And one of them is the scope of practice.
[00:25:34.920]So we have scope of competence
[00:25:37.710]that we talk about a lot in our ethics code.
[00:25:40.950]And your scope of competence is what you feel
[00:25:42.930]you are competent to do.
[00:25:44.640]So whether I'm in a school setting or not,
[00:25:47.910]there are certain things that
[00:25:48.990]I'm really comfortable with and feel competent in.
[00:25:51.930]And there are certain things
[00:25:53.130]that are not within my scope of competence.
[00:25:56.880]In other words, I'd probably look for someone else
[00:25:58.860]to help me with those things.
[00:26:00.480]That's a little bit different than a scope of practice.
[00:26:04.110]So let me give you some examples of that
[00:26:07.470]that are connected or not to this discussion.
[00:26:10.680]We have in our schools, SLPs, we have OTs, PTs,
[00:26:17.580]those are all clinically, medically licensed professionals
[00:26:21.720]that work in the school system.
[00:26:23.820]While their scope of practice per what they can do
[00:26:26.940]is about like that, what they can do
[00:26:28.920]in a school setting is much more narrow.
[00:26:30.930]And there's a very good reason for this.
[00:26:33.510]When we provide services in school,
[00:26:36.630]the main thing we're thinking about is access.
[00:26:40.290]We're not thinking about providing therapy all day long,
[00:26:43.800]we're thinking about what does that child need
[00:26:46.650]in order to access their education, whether it's general ed
[00:26:51.660]or whether it's special ed or a combination of those two.
[00:26:55.590]So in the school setting, I see a lot of
[00:26:59.220]clinic-based providers being very confused.
[00:27:02.490]Well, isn't my expectation that
[00:27:05.340]I'm supposed to do all of these things?
[00:27:07.380]Well, we have to think at all times, is what I'm doing
[00:27:11.400]going to help that child to access special and general ed?
[00:27:15.690]And certainly in the last scenario I gave you, no.
[00:27:19.530]That pullout program is probably
[00:27:22.350]only going to meet that treatment plan
[00:27:24.990]in that BCBA's worldview of how it works.
[00:27:28.320]So we can think about our scope of practice
[00:27:31.230]not as being restricted, but the purpose is different.
[00:27:35.670]So in the school setting, always be thinking
[00:27:38.940]is what I'm doing or asking yourself,
[00:27:40.740]is what I'm doing helping the child
[00:27:42.570]to access general and special education.
[00:27:46.230]So the next fundamental difference is ethics.
[00:27:48.810]And I'm not saying that we don't have them
[00:27:50.520]in the school setting, we obviously do,
[00:27:53.889]and I am guessing that everyone in this room
[00:27:57.450]would probably shake their heads yes,
[00:27:58.980]that sometimes we've run into these issues where we wonder,
[00:28:02.520]does our ethics code and the expectations really match
[00:28:07.050]what is happening in the school setting?
[00:28:09.120]So for example, consent.
[00:28:11.940]Consent comes up all the time,
[00:28:13.650]and I'm skipping around, but I'll come back to that.
[00:28:16.200]Consent in the school setting is highly tied
[00:28:18.840]to the regulations in the IDEA,
[00:28:21.750]but also to whatever your state has decided
[00:28:26.010]they're going to do to implement IDEA.
[00:28:29.310]That is fundamentally at odds with how we are asked
[00:28:34.170]to get consent for everything that we do
[00:28:37.500]according to our ethics code from the BACB.
[00:28:40.890]You know, so what do you do?
[00:28:42.270]In what situation do you abide by the ethics code?
[00:28:46.680]And in my opinion, you need to abide by the school
[00:28:51.270]and what they are doing because you are practicing
[00:28:53.640]in that setting, but always be cognizant of ethical dilemmas
[00:28:58.890]and be ready to report them if you need to.
[00:29:02.760]Big difference between clinic and school
[00:29:05.610]is funding and hours, so I know of no other discipline
[00:29:10.560]that has such generous funding for the hours of service
[00:29:16.110]as our field based on what insurance is providing.
[00:29:19.470]So I know many cases where the student, not the student,
[00:29:25.440]excuse me, the client may have 30, 35, 40 hours a week
[00:29:30.480]of ABA that is provided one-to-one by a technician
[00:29:35.250]that is overseen by the BCBA plus parent training,
[00:29:40.290]maybe plus school consultation.
[00:29:42.840]And that is fundamentally different from what school offers.
[00:29:47.070]So what a point of struggle that I see a lot is a BCBA
[00:29:51.600]will look at that and say, "Well, when they're in school,
[00:29:54.720]they're only getting my services maybe 30 minutes a day
[00:29:59.040]of supervising or consulting with staff.
[00:30:02.310]That seems like less than what I feel they need,"
[00:30:06.420]but we're thinking about that from a clinic perspective.
[00:30:09.450]That child's natural environment is school.
[00:30:12.870]And when they're in that school setting,
[00:30:15.060]our role is to help them to access school.
[00:30:18.690]So we have to shift and that's a hard shift to make.
[00:30:22.230]The next one I would say is lines of report.
[00:30:25.350]One of the things that happened in the last scenario
[00:30:29.430]is the BCBA did what that BCBA would do
[00:30:32.610]normally in a clinic setting.
[00:30:34.110]What would they do?
[00:30:34.980]They would handle their case.
[00:30:38.678]I want to give that person the benefit of the doubt
[00:30:41.370]that what they didn't understand is that
[00:30:43.977]the cert is in charge of the classroom.
[00:30:47.400]That cert teacher is the case manager for the IEP
[00:30:51.180]and we have to work alongside of or in support
[00:30:55.380]of that person rather than circumventing
[00:30:58.530]and going around them.
[00:31:00.090]And that's difficult because that's not the way
[00:31:03.270]that we're used to serving our students at all or clients.
[00:31:08.700]And so that then brings me to
[00:31:10.140]my last point is communication.
[00:31:12.390]In the very simple system of the clinic,
[00:31:15.810]communication is typically with the BCBA
[00:31:19.680]to the parents, BCBA to the RBT,
[00:31:23.100]and maybe working out as an outsider,
[00:31:26.190]maybe working with the school.
[00:31:28.140]But within the classroom, that needs to shift
[00:31:32.640]to where our communication is thought of
[00:31:34.710]as how do I communicate with a team as a team member,
[00:31:38.580]not telling them what to do, but always letting
[00:31:43.110]the message be around how is what I'm doing
[00:31:45.930]promoting access for the student?
[00:31:48.480]How do I help to model that?
[00:31:52.110]How do I work with the case manager to make sure
[00:31:54.540]that they are okay with that since ultimately everyone
[00:31:57.660]in that room is operating under that teacher's license
[00:32:00.870]except for the BCBA and the RBT.
[00:32:03.600]So those are all things that we need to navigate.
[00:32:06.300]And again, pointing to next week
[00:32:08.160]we'll talk about some of the how do we do that,
[00:32:10.710]types of strategies and scenarios.
[00:32:13.560]I think the other thing that's really important
[00:32:15.240]that might be a little mysterious
[00:32:17.250]if you don't know school well
[00:32:18.480]is to understand the hierarchy.
[00:32:19.890]So I tried to make this nice little flow chart
[00:32:22.620]and I hated it, so last minute I took it out
[00:32:25.320]and I made this instead.
[00:32:26.280]So imagine that the arrow is like this.
[00:32:28.410]And we start up here with what is guiding.
[00:32:31.290]What's guiding is the federal and state laws, okay?
[00:32:34.230]So every state puts forth a package saying
[00:32:38.340]this is how we're to implement our schooling,
[00:32:41.430]our basic ed, and our special education.
[00:32:44.580]Those then funnel down to the state department.
[00:32:47.280]So whatever state you're in, there is a state department.
[00:32:50.610]And that state department is responsible for interpreting
[00:32:53.430]and enforcing all the things that need
[00:32:56.190]to happen federally and state.
[00:32:58.470]And then every district has a school board.
[00:33:01.620]And the school board is the boss, the superintendent,
[00:33:04.890]who is the boss of the district leadership.
[00:33:07.440]And that's often where district leadership is
[00:33:09.660]where you might see the special ed administrator coming in
[00:33:13.710]or the district person is coming in
[00:33:16.290]because there's a problem or whatever.
[00:33:18.540]And then we have our principal.
[00:33:20.310]Principal is the person that's in charge
[00:33:23.070]of the entire school and all kids in the school,
[00:33:25.380]including all kids in special ed,
[00:33:28.020]who then supervises certificated staff.
[00:33:31.530]So teachers, SLPs, OTs, PTs, nurses,
[00:33:36.150]everyone, and then classified are, well,
[00:33:39.750]it's a huge category, but in Washington, for example,
[00:33:43.140]paraprofessionals fall in this category
[00:33:46.080]and anyone from the school secretaries
[00:33:50.880]who basically run the building to the health technicians,
[00:33:55.710]interpreters, everyone else that falls in that category.
[00:33:59.610]And a classified person is considered to be non-certificated
[00:34:03.150]and they operate under that certificated staff's license.
[00:34:06.750]So things are being delegated to them as a matter of course.
[00:34:10.250]So this is how it works.
[00:34:12.090]And again, if I know I feel for
[00:34:14.490]the clinic-trained person who comes into school
[00:34:18.930]and all of a sudden there are all these other stakeholders
[00:34:22.500]that you didn't know, you didn't know
[00:34:24.720]that have a hand in all of this.
[00:34:28.860]And Maria is right.
[00:34:30.600]So this is a fundamental thing that all of you need to know.
[00:34:35.580]And I alluded to it, but I'm gonna say it now,
[00:34:38.100]when we get funding, funding in schools
[00:34:41.070]is general and special ed, but even our students
[00:34:44.940]in special education get basic ed funding
[00:34:47.250]and they are basic ed, general ed first.
[00:34:50.040]So if they have an IEP, that is in addition to
[00:34:54.330]what they should be getting as general ed students,
[00:34:57.600]which is why that term access becomes
[00:35:00.570]so very important because that is our job.
[00:35:04.020]All of us are there to help that student
[00:35:06.900]to access general and special education.
[00:35:09.510]So Maria, it's all buildings.
[00:35:11.520]It's not just the majority.
[00:35:12.840]I guess the minority would be those
[00:35:15.420]that are in a building where everyone has an IEP,
[00:35:19.170]but that is rare, especially,
[00:35:22.020]well in most states it's pretty rare.
[00:35:23.460]But thank you very much for pointing that out.
[00:35:26.100]So this is just something to be aware of
[00:35:28.260]that the hierarchies are different
[00:35:29.670]and there's more players, there's more layers
[00:35:33.300]of complexity in a school setting.
[00:35:35.640]And that's something I think just being aware of that
[00:35:38.790]will get you a long way to kind of answering
[00:35:40.980]the what is going on here question.
[00:35:43.620]So there's a couple of vocab terms
[00:35:45.510]that I really wanna make sure that you understand
[00:35:48.120]as you are operating in schools.
[00:35:49.860]So I know that ABA prep programs across the country,
[00:35:55.950]we all have to follow the course sequence.
[00:35:58.380]So there are basically seven courses
[00:36:00.540]and seven like basically seven things you have to do
[00:36:04.230]class-wise in order to get that certificate.
[00:36:07.740]But the interpretation of this varies a lot.
[00:36:11.910]And some of our BCBAs come out well-trained
[00:36:14.940]in understanding school and others aren't.
[00:36:18.540]So when we are, and this is more to the administrators
[00:36:22.260]in the room when we are onboarding people
[00:36:24.660]who are clinic trained and who might not have
[00:36:27.060]a good understanding, these are things that
[00:36:29.310]we might assume they know and they don't.
[00:36:31.200]And this can get us into a lot of trouble
[00:36:33.330]if we are the administrator trying to work
[00:36:35.670]with someone who's just not familiar.
[00:36:38.850]So what are these things?
[00:36:40.890]Within the IEP, so the IEP again is that offer of FAPE.
[00:36:45.873]The IEP includes something called SDI
[00:36:48.450]or specially designed instruction,
[00:36:50.940]and that is the actual services.
[00:36:54.630]So when you hear services, that is the majority
[00:36:58.290]of what is in the IEP.
[00:36:59.280]It's not all of it and we could definitely digress
[00:37:02.970]and talk about IEPs all day long.
[00:37:05.190]But that specially design instruction
[00:37:06.990]is something that is based upon
[00:37:09.480]that impact the disability has created.
[00:37:13.230]Now, SDI or specially designed instruction
[00:37:16.200]is special education, but there's also
[00:37:19.380]something called a related service.
[00:37:21.930]And that is a service design to help
[00:37:24.600]that student to access special ed.
[00:37:26.910]So that might be, yes, we might be helping a student
[00:37:31.650]who has an IEP who also has significant behaviors
[00:37:36.330]which are creating a barrier to accessing special ed.
[00:37:41.010]So we might provide a related service in order to help
[00:37:44.310]that student to benefit from special ed.
[00:37:47.490]So that's one way that can look.
[00:37:49.860]Can look a lot of different ways actually.
[00:37:52.020]And that's all within what we call the IEP,
[00:37:54.540]that guarantee of services or that guarantee of FAPE.
[00:37:57.750]FAPE means free and appropriate public education.
[00:38:05.400]FAPE is a big, big topic in the special education world.
[00:38:10.320]So free, meaning at no cost to the family,
[00:38:13.560]appropriate, which is a hotly,
[00:38:15.780]that is the most hotly debated part of the acronym.
[00:38:19.320]What is appropriate?
[00:38:20.580]Well, it really depends on the student and their context
[00:38:24.930]and what they require in order to have access
[00:38:28.830]and appropriate used to be somewhat like, you know,
[00:38:32.670]as long as we're doing good by them
[00:38:34.290]and as long as they're making a minimum gains, we're okay.
[00:38:37.410]But that has changed.
[00:38:39.270]And now we have to show a fairly rigorous attempt
[00:38:43.530]at creating progress for that student
[00:38:46.890]in light of their circumstances.
[00:38:48.360]So the P is public, meaning that it's publicly funded,
[00:38:52.860]sometimes when kids go to non-public settings,
[00:38:56.340]and it's an education, it's not just something trivial,
[00:39:00.090]that it truly is, it is an educational program
[00:39:04.770]that is designed to help that student
[00:39:06.390]to make progress and to benefit.
[00:39:09.210]So FAPE is a big term that I know
[00:39:13.500]you've probably heard a hundred thousand times
[00:39:16.140]and it really is what drives everything.
[00:39:19.500]We also have something called compliance.
[00:39:22.200]And here's what you might hear when thinking about
[00:39:24.720]compliance, that we have to do a new IEP every 365 days
[00:39:31.860]or we have to make sure that after an IEP meeting,
[00:39:35.910]we send prior written notice to the family
[00:39:39.360]indicating what we chose to do or decline to do.
[00:39:43.230]Compliance is sometimes called process or the procedures.
[00:39:49.665]And really the driver here is that if we are in compliance,
[00:39:53.670]that student is in part accessing a FAPE.
[00:39:57.060]It's not all of it because
[00:39:58.290]we also have the substance, right?
[00:40:00.810]The specially designed instruction,
[00:40:02.700]the combinations we're providing, the services,
[00:40:05.850]that's the other part of this.
[00:40:07.830]The procedural safeguards are a document
[00:40:11.190]that explains the rights of that student
[00:40:14.370]to access their education because they have an IEP.
[00:40:18.660]So every state department has their own copy
[00:40:22.590]and you might hear things like we have to offer them
[00:40:25.560]every year to the family to stay in compliance.
[00:40:29.220]There's lots of ways that this plays out.
[00:40:31.230]Here's my advice, get a copy and read it.
[00:40:35.880]I would have said that 20 years ago,
[00:40:38.160]it would've been really confusing, but I think
[00:40:41.010]over the last couple of decades,
[00:40:42.570]they've gotten to be more palatable.
[00:40:44.820]I really like Washington State's
[00:40:46.650]because I live there, it's what I'm used to.
[00:40:49.560]But I would encourage you to just take a look at it
[00:40:52.710]and just see, you know, what is it that's driving everything
[00:40:55.950]and all the vocabulary that you're kind of stuck on
[00:40:58.770]will be in there as well.
[00:41:00.570]We've gone over what is certificated
[00:41:02.520]versus what is classified.
[00:41:04.170]But here's something I want you to know.
[00:41:06.090]In the school setting, the paraprofessional in the room
[00:41:10.320]is being supervised by the certificated teacher.
[00:41:14.400]It doesn't mean they're being evaluated,
[00:41:16.530]but they're being supervised.
[00:41:17.850]And what that really comes down to is that we
[00:41:20.490]as a certificated person are designing the programming.
[00:41:25.920]We are delegating and training and we are checking progress,
[00:41:30.720]not unlike what we do in a clinic setting.
[00:41:34.140]So if that helps you, I guess here's why
[00:41:36.900]this is so important is because
[00:41:38.670]when you walk into that school,
[00:41:40.770]you are no longer the apex in charge.
[00:41:43.980]You are then part of a team understanding that
[00:41:46.980]there is a certificated person who is in charge
[00:41:50.280]of those IEPs and you are providing
[00:41:54.090]other services or alongside.
[00:41:56.790]What might that look like?
[00:41:57.900]You might be designing curriculum or approaches
[00:42:01.950]or a token system or whatever, delegating it,
[00:42:06.060]but working alongside the certificated staff member,
[00:42:09.540]engaging in role release.
[00:42:11.280]So role release is something that
[00:42:13.920]I'm very heavily into when it comes to collaboration.
[00:42:16.530]The idea that I am not the only one
[00:42:19.050]that holds the expertise.
[00:42:20.220]So for example, I know there are some people,
[00:42:23.760]some BCBAs out there that say only a BCBA
[00:42:26.970]should write an FBA and BIP.
[00:42:30.240]No.
[00:42:31.500]Why?
[00:42:32.580]Only in the very most complex circumstances
[00:42:37.650]should we ever take that position.
[00:42:40.260]Instead, we should be acknowledging
[00:42:42.900]that everyone on the team has something to offer.
[00:42:47.130]We may want to train people on how to take indirect
[00:42:51.750]and direct data and how to pull all those pieces together.
[00:42:56.610]Progress monitoring is a district-wide initiative
[00:43:00.840]where we are repeatedly assessing students.
[00:43:03.900]Are they making progress?
[00:43:05.130]Do they understand?
[00:43:06.600]Where are the holes?
[00:43:07.830]How do we fix this?
[00:43:09.900]That is occurring district, school,
[00:43:11.880]classroom and individual.
[00:43:13.530]And finally, collaboration.
[00:43:15.810]In the school setting collaboration means that
[00:43:19.830]every team member comes together to provide
[00:43:24.540]a well, I guess knitted together blanket
[00:43:27.870]of services for that student.
[00:43:29.850]In other words, we're never to work alone
[00:43:33.090]because that just doesn't make any sense in that setting.
[00:43:35.940]We aren't in a clinic, we're in a school setting
[00:43:38.010]where there are multiple players at all times.
[00:43:41.160]Okay, so I want to quickly then
[00:43:47.790]for the next 13 minutes go back to the scenario.
[00:43:52.170]So give me just a second to go back to the first one
[00:43:56.490]now that we have had this conversation.
[00:44:00.630]Let me get out of here and share.
[00:44:04.560]What do you think you would do to address this situation?
[00:44:10.920]Remembering that this is the one who had a six-hour RBT.
[00:44:19.320]And so we're now bringing it down to three with that student
[00:44:25.530]and then the other three on another student
[00:44:27.960]who I guess their insurance is gonna pay for that somehow.
[00:44:30.930]I don't know how that even happened.
[00:44:33.210]But then you notice that there's no FBA or PBIP,
[00:44:37.260]they're using the treatment plan.
[00:44:40.200]What are the things that need to happen here
[00:44:44.640]based upon what we just discussed?
[00:44:49.050]And you can go ahead and put your information
[00:44:51.570]or your thoughts into the chat.
[00:44:54.030]What might we want to do?
[00:44:59.550]And I'm gonna pick a couple and talk about them.
[00:45:09.210]Okay, I'm just gonna wait for a few to pop up.
[00:45:25.380]Okay, I'll wait until I get a few more.
[00:45:32.850]Okay.
[00:45:36.750]Great, lots and lots of wonderful things.
[00:45:39.720]Let's start with the BCBA should offer as a team member
[00:45:44.190]to help with the FBA and BIP.
[00:45:46.830]So yes, so the FBA and the behavior plan
[00:45:50.160]should never be the treatment plan from the clinic.
[00:45:54.570]This student, if they have behavior that is a barrier
[00:45:58.590]to access actually is entitled to an FBA and behavior plan.
[00:46:03.780]And I would hope that their IEP listed behavior,
[00:46:08.340]social emotional as an area that they qualified in.
[00:46:12.540]If that's not the case, then we have a different discussion.
[00:46:15.930]But at a minimum, this student's IEP
[00:46:20.070]should include an FBA and BIP.
[00:46:22.170]And I like how you said should offer
[00:46:24.480]as a team member to help.
[00:46:26.820]There is a process with that, but it is important
[00:46:29.100]to know that it should be there.
[00:46:31.140]Let's look at the next one.
[00:46:32.190]Work with the school team to do an FBA, BIP,
[00:46:35.280]help train the team.
[00:46:36.240]Yeah, we can provide training and coaching for sure
[00:46:40.470]within the different context that that student is in.
[00:46:43.320]Absolutely.
[00:46:44.580]So let's look at the next one.
[00:46:46.800]Suggest school complete FBA BIP
[00:46:49.440]as this was written in clinic
[00:46:51.240]and provide training and support.
[00:46:52.560]Yes, so what I hear you saying, Jessica,
[00:46:54.240]is the context is different.
[00:46:55.980]So in a clinic we have this very kind of narrow lens
[00:46:59.760]where we have a lot more instructional control
[00:47:02.430]than in the school setting where we might not
[00:47:05.070]because there are other kids and other people
[00:47:06.897]and the bell is ringing and there's PE,
[00:47:09.150]music, library, all these things happening
[00:47:11.550]that we don't have access to
[00:47:13.980]in a more controlled and contrived setting.
[00:47:17.040]So yes, you're identifying right away
[00:47:18.900]that FBA BIP is needed.
[00:47:21.090]And then another person says, a team collaboration needs
[00:47:24.540]to happen to address all the needs of the child,
[00:47:26.760]train them how to implement a BIP.
[00:47:29.250]I would agree with you.
[00:47:30.690]So there is this mantra that I want all of you to remember
[00:47:35.640]that everything has to be decided
[00:47:38.910]within the context of an IEP team meeting.
[00:47:42.000]So when I look at this case,
[00:47:43.530]the first thing I think about is,
[00:47:45.030]whoa, we need to get together.
[00:47:47.670]We need to look at the evaluation,
[00:47:50.430]we need to look at the IEP, and we need to figure out,
[00:47:54.060]all right, what's next?
[00:47:55.410]Does the eval match the IEP?
[00:47:57.720]Are there behavior minutes in the IEP
[00:48:00.300]and then start that FBA and that behavior intervention plan.
[00:48:04.890]And that is a team-based collaboration.
[00:48:08.040]But I think that the other thing,
[00:48:10.230]and maybe it's further down the line here, is that
[00:48:13.500]I want to go back and look at the contract
[00:48:15.810]that that outside clinic has with the school
[00:48:18.090]and how did we get there, what was agreed upon,
[00:48:21.570]and now what are we going to do in order to create something
[00:48:25.650]that is truly about access to the school setting?
[00:48:28.890]So great job on that.
[00:48:30.960]We do want to help build capacity and scaffolding, right?
[00:48:34.110]We're not the only expert.
[00:48:35.370]So when we engage in role release,
[00:48:37.650]if we can build capacity in this setting,
[00:48:40.140]they're now better prepared to deal
[00:48:42.570]with the next five complex cases
[00:48:45.180]that come along this year or next year.
[00:48:48.090]So I love that recommendation.
[00:48:50.700]Have a collaboration meeting to discuss role and a new plan.
[00:48:53.880]Yes, so one of the things that's missing here
[00:48:55.830]is that a clear definition of the roles
[00:49:00.240]that everyone should be playing in this setting.
[00:49:03.930]So what exactly is the para doing?
[00:49:07.470]What is the RBT doing and what are
[00:49:10.680]the cert teacher and the BCBA doing?
[00:49:14.250]And were I the administrator, I would want that
[00:49:17.580]clearly defined well in advance of services starting,
[00:49:22.140]like an antecedent-based intervention for how this is going
[00:49:25.170]to work together in the school setting.
[00:49:27.690]And then from there, that new plan, as Leah's saying,
[00:49:30.630]might be a new plan that the agency has
[00:49:33.990]or a new plan for the team as a whole.
[00:49:37.170]And then we have another call, a team meeting.
[00:49:39.990]Yes, so we need to make sure that we are always
[00:49:43.470]empowering the school to be that team,
[00:49:46.500]to be the driver of services.
[00:49:49.320]Work with the school team to ensure that
[00:49:51.180]all members are involved,
[00:49:52.440]that the IEP is also being followed.
[00:49:54.000]Absolutely, because if we're not doing that,
[00:49:56.580]then we aren't ethically holding to our standard anyway
[00:50:02.310]and we're denying that child a FAPE.
[00:50:04.410]By the way, the next code word is going to come up
[00:50:08.040]and I'll do it in just a few minutes,
[00:50:09.690]so hang tight for that.
[00:50:11.910]All right, great suggestions.
[00:50:14.130]Team collaboration, yes, cross collaborate.
[00:50:17.160]Okay. so I'm gonna take that
[00:50:19.140]according to how I think about it.
[00:50:20.820]Terry, if I'm wrong, then I'll look
[00:50:23.010]for your answer in a minute.
[00:50:24.870]When we cross collaborate, we accept
[00:50:26.880]that other people also have expertise.
[00:50:29.130]So what about the teacher?
[00:50:31.530]What expertise does that teacher have
[00:50:33.780]of what needs to be accessed?
[00:50:36.390]So what is their curriculum?
[00:50:38.010]How is it being provided?
[00:50:40.290]Is it small group, large group, individual?
[00:50:42.900]Is it reading, written language, math?
[00:50:45.030]What are the fundamental issues?
[00:50:47.160]The SLP should be the expert when it comes to communication.
[00:50:51.390]So if we are providing any kind of
[00:50:53.460]functional communication type training,
[00:50:55.860]the SLP is the one who really needs
[00:50:58.020]to help us to design that.
[00:51:01.290]And that is cross collaboration for sure.
[00:51:04.800]Work together, yes.
[00:51:06.780]It is the school's responsibility to put this together
[00:51:09.090]but the BCBA can provide suggestions.
[00:51:11.040]Absolutely, right?
[00:51:12.600]It's not like what we're saying is
[00:51:13.677]the clinic has no input to give.
[00:51:16.320]Of course they do.
[00:51:17.370]It's that we need to make sure that we are thinking always,
[00:51:20.490]this is the school and how are we going to empower them.
[00:51:24.723]It's a lot we can learn from each other.
[00:51:26.850]Model, absolutely.
[00:51:28.440]How to support success, fading out that RBT.
[00:51:31.170]One thing the school keeps saying is,
[00:51:33.090]we don't need the RBT anymore.
[00:51:35.130]We should be listening to that.
[00:51:36.750]Let's fade that back and let's train the professionals
[00:51:40.080]that are there so that they're confident for the next cases.
[00:51:44.160]Terry said exactly.
[00:51:45.330]Unified, holistic approach, multidisciplinary.
[00:51:48.930]So I am greatly impressed by
[00:51:51.660]what you have already mentioned so far.
[00:51:55.710]So in this scenario, I would say
[00:51:59.400]we probably missed an opportunity to devise a robust plan.
[00:52:05.670]Now there's one thing I have not heard.
[00:52:08.790]I mean, and not exactly, and that is that,
[00:52:10.800]that this clinic-based person needs some training
[00:52:13.910]in what does school mean.
[00:52:16.230]What is an IEP?
[00:52:17.490]What's an IEP team?
[00:52:19.230]What is driving this case?
[00:52:22.020]How do we make sure that what we are doing supports that?
[00:52:26.190]And so I know my heart goes out to this person who thought,
[00:52:30.120]well, I'm gonna do the good work I do in a clinic
[00:52:32.430]and just put it in the school setting.
[00:52:34.200]And that to me is a training issue
[00:52:36.780]that we should all be thinking about.
[00:52:39.060]And that gets to actually something that I see
[00:52:41.280]as the last comment is collaboration
[00:52:42.990]with all stakeholders is always a very good approach.
[00:52:46.170]The last code word is collaboration.
[00:52:48.960]So when you do your survey checkout,
[00:52:51.900]collaboration is the second code word for your CEUs.
[00:52:55.920]Are there any more comments or questions
[00:52:58.440]before our hour is up, which is coming up
[00:53:02.683]way quicker than I thought it would.

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ABA in Schools: It's a Different World Part 1

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