Family Engagement and Care Coordination Key to Positive Outcomes

Dr. Amanda Kelly, BCBA-D lives and breathes family engagement in therapy.

As the Director of Home-Based Services at Firefly Autism Services, Dr. Kelly focuses her efforts on supporting learners and families, and she is an expert in care coordination. We are grateful to have had the opportunity to talk with Dr. Kelly, and we are happy to share her expertise with you in this exclusive blog post.

We hope you enjoy it! Read to the end to find out how you can get in touch with Firefly Autism Services and Awake Labs.

Are there strategies that your therapists use to encourage families to participate in therapy?

We very much believe in leading by example. Our team of BCBAs and RBTs work closely with families, and we request that parents and caregivers are physically present during our sessions. Together, we ensure the professional relationship is one built on trust. Showing a family how they can get to a result they desire is the best way to gain trust. It is our responsibility to demonstrate effectiveness with our treatment. When we can do that in the presence of the family, the engagement we seek comes naturally.

What are some signs that a family is engaged in your therapy?

Productive family engagement in therapy can look very different from family to family. Individualizing all elements of therapy is a core feature of ABA, from the interventions themselves to the consideration of specific family dynamics. For the most part, physical presence in sessions and involvement in treatment is the ideal scenario. Other signs of productive family engagement can include:

  • Willingness to collaborate on interventions
  • Taking data outside of session times
  • Being open to training and feedback on the implementation of a behavior plan

On the other hand if a family has never been given the opportunity to collaborate or have their opinion heard, this will amount to less than satisfactory outcomes for all involved.

Can you share your thoughts on what could happen if a family is not given the opportunity to collaborate and share their opinion?

It is essential for us behavior analysts to understand what the family and the person we support really value for optimal quality of life. We need to ask “what is the most important thing for this family”? If we make assumptions about what is important for any family, we run the risk of projecting what we want for them, not what they really want.

When this happens, the BCBA might ask that the family implement a strategy that addresses what the BCBA wants. The family might not be as invested in that case. They will be less likely to truly engage with the treatment recommendations. However, when the end goal of therapy reflects what the family wants, they will be much more likely to consistently implement our recommended interventions.

The other essential piece is understanding what is possible for the family. In a 2019 document clarifying ABA treatment of Autism Spectrum Disorder, the Behavior Analysis Certification Board (BACB) and the Association for Professional Behavior Analysts (APBA) stated:

“For some families, the time and effort that can be devoted to acquiring skills to implement ABA procedures is constrained by … the number of parents in the household, parental employment outside the home …, the needs of siblings and other family members, language differences, and financial and other resources.” 

It is our responsibility to give families the opportunity to share their challenges. We must consider the variables that may pose a barrier to family engagement, and make sure that we are designing our programs in a way that both the person we support and their family can be successful.

Why is collaboration and coordination of care across disciplines so important?

There are lots of people involved from diagnosis across treatment and education. Pediatricians, psychiatrists, psychologists, speech and language pathologists, occupational therapists, applied behavior analysts, and education/special education teams may all have a part to play in the care of an individual and their family. Each discipline has a unique and valuable approach and perspective.

Collaboration and coordination of care across disciplines is important because it will exponentially improve the chances of meaningful learning and progress. Giving the opportunity for teams to share information and opinions will ensure the best possible chance of generalization and maintenance of skills.

What does true care coordination look like?

From the perspective of a behavior analyst, true coordination means connecting and working together with each of the other providers in a flexible and dynamic way. It means we all work towards a common goal – meaningful independence and adaptive functioning for the person we support. True coordination allows for skills to be taught as a team, and generalized across all settings, situations, and individuals in that person’s life.

Imagine this scenario: A BCBA has developed a protocol that can teach a learner some alternative communication skills. However, the BCBA did not communicate the protocol with the learner’s school, or with the learner’s speech therapist. As a result, the BCBA, the school, and the speech therapist end up working on contradicting communication goals. This means that progress is slow, because there are too many goals with too varied a focus.

Now, if collaboration was a priority, the BCBA, the speech therapist, the school, and the family would discuss and work together to focus on the same communication goal. During this discussion, the BCBA and speech therapist find out that the school wants to use an intervention that will be minimally disruptive to the class. So, they collaborate to come up with an intervention strategy that is minimally disruptive. The family also learns this strategy and implements it at home. Now, the BCBA, speech therapist, school team, and family are all using the same intervention strategy to work towards the same communication goal. Progress accelerates and the whole team benefits as a result.

From your perspective as a BCBA, what concrete steps need to be taken for care coordination to be a reality?

At the start of the process, it is essential to identify what the person being supported and their family really value for optimal quality of life. Once this is achieved, reaching out to the other professionals working with the family is the next step. Observing the person we support in all of the different contexts and environments in which they live is extremely valuable. Creating relationships for the purpose of a common goal is essential for coordination of care to be possible.

There is also the necessary consideration of what is the most important thing that other professionals are addressing. For example, if I am insisting on addressing something that a school doesn’t really see as problematic – or if I am recommending an intervention that they simply don’t have the resources to implement – the likelihood that consistent coordination of care will occur is low.

Ultimately, in order for consistency and coordination of care to be a reality, there needs to be a dynamic, flexible approach by everyone involved with a focus on practicality and feasibility.

We often hear that all behavior is communication. As a self-described “radical behavior analyst”, what do you do to understand your learners’ thoughts as they are communicated through behavior?

For the purposes of explanation; “The radical behaviorist approaches mentalistic terms in the same way as any other behavior …” (Barnes-Holmes, 2003, p.145), where mentalistic terms refers to our thoughts or thinking. Extending on this, contextual behavioral scientists believe that it is necessary to view behavior as tied to, or a product of, a person’s historical and current context. I consider these approaches invaluable for a broader understanding of behavior.

Language doesn’t stop at words that can be heard. Thoughts or thinking are still verbal behavior. From my perspective, the question is less about measuring the exact thoughts in a learner’s head at any given moment, but more so understanding the history of the learner. I want to understand how past and current context, as well as the social environment in which they operate can have an effect on learning and behavior.

Let me illustrate the utility of this. Imagine that I am working with a learner that has mastered a variety of social skills in a variety of contexts. However, they appear to be unwilling to engage with their peers. Now, this learner may have a history of bullying by peers in a previous school. They frequently have thoughts like ‘I’m not popular’, ‘nobody likes me’, and ‘I’ll never be good enough no matter what I do’. When it comes time to use social skills it may be less of an issue of mastery, but more of an issue of the learner’s thoughts that are the result of a previous experience.

In this instance, having insight into the learner’s thoughts would be very valuable. As an analyst with an understanding of the importance of context and history, I might be more likely to think in these terms when faced with non-obvious barriers to successful outcomes.  My approach might be more focused on practicing positive self-talk, arranging environmental contingencies that are sure to provide reinforcement for attempting to engage a peer, and a separation of the self from thoughts.

Call to action!

Dr. Amanda Kelly, BCBA-D is the Home-Based Programs Director at Firefly Autism Services in Denver, CO. Any reader who would like to connect with Dr. Kelly is welcome to do so by sending her an email at AKelly@fireflyautism.org. Also, Firefly Autism Services is now offering ‘Parent Support and Training Groups’ in Denver. Email Dr. Kelly if you are in the Denver area and would like to participate!

Would you like to be featured in a blog post by Awake Labs? Send an email to paul@awakelabs.com with the subject line “New Blog Idea!”

References:

Barnes-Holmes, D. (2003). For the radical behaviorist biological events are not biological and public events are not public. Behavior and Philosophy, 31, 145-150.
Behavior Analysis Certification Board. (2019). Clarifications Regarding Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers. (2nd ed.) p.3. Retrieved from https://cdn.ymaws.com/www.apbahome.net/resource/collection/1FDDBDD2-5CAF-4B2A-AB3F-DAE5E72111BF/Clarifications.ASDPracticeGuidelines.pdf


Teamwork Between Autism Professionals Essential for Personalized Care

It is common for autistic people and their families to seek a wide variety of services to help them be supported and successful in the world. In 2014, the CASDA National Needs Assessment Survey reported that caregivers of school age youth (5-17 years old) used on average 3.2 services from autism professionals in the last 6 months. The amount used ranged from zero to 13 services. This does not count any supports received at school.

As a result, people with autism and their families can end up surrounded by a circle of care.

A group of four people smiling at the camera

It is hugely important for everyone involved in the circle of care to communicate and stay on the same page. In this post published on the American Speech and Hearing Association (ASHA) blog page, the author Rosemarie Griffin, MA, CCC-SLP, BCBA argues that:

“Professionals working toward common goals help their students increase overall engagement… Teamwork between autism professionals can also better teach our students to develop and use functional communication skills across a variety of instructors and environments.”

The Geneva Centre for Autism shares similar advice for teachers to welcome autistic students in their classroom. They recommend:

“…daily communication [should] involve the student, and the teacher [should] read and sign the [communication book] every day and write in it often. Call parents to share good news, and discuss difficult issues by phone or in personal meetings… Let parents know what learning was demonstrated, what new words were learned, and other achievements.”

A woman smiling holding a marker and standing in front of a classroom

People with autism and their families will find that different types of autism professionals may need different types of information in order to provide support. To help make sure that everyone has access to the information they need, it is important to maintain open lines of communication. It is also important that everyone has a good understanding of the health and learning goals being worked on. One way to do this is to use the S.M.A.R.T goals approach – Specific, Measurable, Attainable, Realistic, and Timely – to keep everyone on the same page.

Bonus tip:

S.M.A.R.T. goals work best when they reflect what is important to the person being supported. One-page profiles, and the F-words Profile are great resources for the circle of care to understand what is important to the person being supported.

A young girl writing on a sheet of paper leaning against a table

There are many different tools that exist to help maintain good communication and information sharing with your team. Some people like using an individualized education plan (IEP) binder to keep track of progress at school, as well as communicate and collaborate with teachers and other professionals. We’ve met care teams who share information on Dropbox; others like to get their teams together and meet face to face.

Awake Labs has also created a free tool for better communication and collaboration. It’s an app that is like a high-tech communication book. Parents, teachers, and therapists are using it to keep track and share information related to health and learning goals. This app, Reveal Stories, securely shares pictures, videos, and notes with every person in the circle of care.

Bonus tip:

Reveal Stories is mobile, secure, and can be used by autistic people and their care teams in every aspect of their day to day lives. Your information is at your fingertips for when you need it. Whether it’s pulling up data during team meetings, or reviewing achievements at the end of the day, Reveal Stories can help!

Four different shapes above the words "Awake Labs"

To people who are familiar autism, there is a popular saying that goes: “if you’ve met one person with autism, then you have met one person with autism.”

What this saying means is that each and every person is unique. There is no one definition of autism. And since there is no one definition of autism, then there is no one-size-fits-all approach to building on a person’s strengths and meeting their unique needs.

Effective communication and collaboration are essential to make sure that everyone in the circle of care are working together to support the person with autism at the centre of that circle.


Clinical Leadership in Autism Care with Dr. Rue

Dr. Hanna Rue is a leader and a driving force in the implementation of best clinical practices for people with autism and their families.

Her list of accomplishments includes leading the National Standards Project, which is the second iteration of the largest systematic review of educational and behavioral literature for autism. Now, as the Head of Clinical Development at the LEARN Behavioral Network, Dr. Rue and her team are on a mission to develop a nation-wide clinical infrastructure that will increase the standard of care for autism and provide much-needed services to thousands of families across the US.

We are honored to have had the opportunity to speak with Dr. Hanna Rue. In this exclusive blog post, we detail some of the challenges that come from being on the leading edge of service provision for autism. We also discuss exciting technology opportunities and share Dr. Rue’s advice to aspiring behaviorists.

We hope you enjoy this post! Read to the end to find out how you can get in touch with LEARN and Awake Labs.

A picture of a woman smiling
Dr. Hanna Rue of the LEARN Behavioral Network

During this phase of rapid growth at the LEARN Behavioral Network, how do you maintain trust and integrity in your services?

It really comes down to the people in key positions, communication, and scalable system design. When you have motivated and talented people in leadership positions anything is possible.

Our clinical leadership includes individuals with years of experience working with families and clients in a variety of settings. All of our clinical leaders maintain some work in the field. This allows for opportunities to model best practices for other clinicians and is important to determine the impact that new systems or changes may have on the families we serve.

Ongoing communication is also critical and we maintain standing meetings that include data-based decision making at a systems level. We’ve adopted systems such as Feedback-Informed Care (FIC) that allows us to monitor each family’s perception and satisfaction with service delivery. Systems such as the FIC are piloted with a relatively small group of clinicians and families and then rolled out to the rest of the company in a systematic manner. This allows leadership to address any issues and ensure all necessary supports are in place before we expand the system.

As diagnostic rates increase, more families find themselves stuck on waitlists; how does building a nation-wide infrastructure help address this challenge?

It is an unfortunate truth that there aren’t enough BCBAs in the U.S. to meet the need. We set up our regions and centers with a focus on having people with knowledge of the community. It’s important to maintain close relationships with local physicians, hospitals, and community groups to understand the availability of resources. We work hard to avoid waitlists and maintain contact with our families on waitlists. If a family is on a waitlist for an extended period of time, we will make every effort to find a quality provider to get the family access to services.

Our agency maintains a really active recruiting effort and we have the ability to offer positions across many different regions in the U.S. Many of our clinicians are guest lecturers in university-based BCBA programs and undergraduate programs. Using this platform, we can highlight the many benefits of working with individuals with autism and inform students of the great need in the industry. This not only helps our recruiting efforts but also the field, as it may inspire some undergrads to consider ABA as their career choice.

A mother and son. The mother is smiling. Their faces are touching

Based on the results of the 2015 National Standards Project, where do you think the research community should concentrate its efforts in order to have the most impact for people with autism and their families?

What was surprising was the lack of studies regarding the use of technology. We certainly reviewed more studies involving technology in the second iteration of the National Standards Project. I think there is so much more to learn regarding the use of technology and ABA for individuals with autism. The second iteration of the NSP included an evaluation of interventions for adults (i.e., individuals 21 years of age and older). It was troubling to only have 28 studies meet criteria for inclusion in the review. Children with autism grow up to be adults with autism who can benefit from applied behavior analytic strategies. I think focusing on effective strategies for adults with ASD is imperative.

Two men smiling and laughing together. One is a young man wears a hat. The other is an older man with grey hair

What are some of the most exciting technologies currently available to clinicians? How will these technologies ultimately change the clinical landscape?

There are still many clinicians who have yet to use electronic data collection systems. It is exciting to work with clinicians learning to use this technology, as there is often a dramatic increase in efficiency regarding programming and visual analysis of graphical data. Telehealth is another useful technology for behavior analysts. LEARN clinicians make use of video conferencing for clinical direction, parent consults, collecting independent observer assessments (IOA), and training. Video conferencing keeps clinicians across the country connected and enhances collaboration.

Several LEARN clinicians have been using virtual reality (VR) headsets to evaluate how the technology may contribute to skill acquisition programming. I think VR may offer increased learning opportunities for some of our clients. We’ve worked on teaching joint attention using VR and considered VR for safety skills training as well. Finally, I’m really excited about wearable technology. I think there is more research needed to determine how wearable devices might help clinicians develop more sophisticated programming around reducing challenging behavior.

You oversee a lot of graduate research projects. How do graduate students impact LEARN and the day-to-day activities in your clinics?

Graduate students are tremendous assets to LEARN. They are motivated and curious. By supporting graduate students we are shaping future clinicians who can grow to be leaders at LEARN and in the field of behavior analysis. The science of behavior analysis is evolving and applied techniques are becoming more sophisticated. We can contribute to our greater knowledge of the field by having opportunities for clinicians to engage in scholarly activities such as practicums and thesis projects. The majority of our graduate students are focused on single-subject research projects that lead to improvements in client treatment plans.

I think in terms of day-to-day activities, the grad student projects enrich our programming. The behavior technicians become involved via data collection and often consider pursuing an advanced degree and that is really exciting. The projects also highlight to our clinicians the importance of scholarly activity while engaging in service delivery.

A picture representation of a network

There are more and more people interested in pursuing a career in behavior analysis. What advice would you give to new professionals in this space?

Take time to explore all of behavior analysis. Many clinicians work with individuals with developmental disabilities but behavior analysis is so much more. I so value my time in an operant lab. I truly think it helped me to better understand the impact of the environment on behavior. There are also incredible opportunities in areas focused on animal behavior, gambling behavior, substance abuse, and organizational behavior management just to name a few. Listening to leaders in the field like Dr. Pat Friman discuss the vast possibilities of behavior analysis in our world is truly inspiring and may pique your interest in something you’ve not previously considered.

Call to action!

The LEARN Behavioral Network is growing rapidly. If you would like to get in touch and learn about existing opportunities, send an email to info@learnitsystems.com

Do you have an idea for a blog post that you’d like to share with Awake Labs? Send an email to paul@awakelabs.com with the subject line “New Blog Idea!”


Reducing waitlists for autism services in Ontario

Sara John, BCBA moved back to her home province of Ontario to help reduce the waitlist for autism services. This is no small task; thousands of people with autism and their families are struggling to get support, waiting on some list, somewhere.

Sara gained valuable experience while working with a well-established company in Florida called Positive Behavior Supports Corp (PBS). She is excited to apply what she’s learned to help reduce the waitlist in Ontario.

We first met Sara at the Geneva Symposium in October and caught up with her recently to hear more about how she is serving families in the Greater Toronto Area (GTA).

After working with PBS in Florida for the past 5 years, you returned to your home in Toronto. Welcome back! Can you share with us what inspired you to come back to Canada and what excites you most about working with kiddos & families here?

When my husband and I decided we wanted to come back here, I began researching potential jobs in Ontario. The more I researched the state of autism services in Ontario, the more I realized how many families are struggling to get support, waiting on a list somewhere.

Although I know we can’t reach everybody, I am hopeful we can help at least a few families improve their quality of life. This was the reason I approached the corporate team at PBS to pitch the idea of setting up a branch here in the GTA. They shared my vision to make this international move a reality, and here I am!

How are you using what you learned during your time in Florida to support families in the GTA?

While I was in Florida, I gained valuable experience and knowledge in ABA from amazing and talented mentors. I worked with people of all ages and with a wide variety of strengths and needs. PBS has given me many opportunities to grow, which I hope to share with my team here in Ontario.

In my current role as a regional coordinator, I will not be working directly with many families. I am here to help my team better themselves as therapists. My goal is to help them increase their knowledge, experience, and understanding of ABA as well as their ability to become strong leaders in the field. This will help us reach many more families in our province.

You shared a story with me about a family who ended up “firing” you because you did your job so well. What kind of advice would you give to a new family so that they too can also end up “firing” you?

I want to clarify, the reason that the family didn’t need my services anymore wasn’t because the child didn’t need ABA; rather because the family was much more capable of implementing ABA on their own.

The reason they were able to do this – and any parent can also do the same – is because they understood the necessity for consistency. The family was implementing the recommended strategies in the home the same way our staff was implementing within session.

The most important factor is consistency. It is also the most difficult. It is easy for a provider to come in, recommend changes and then leave. If this is the case, families will have difficulty implementing strategies consistently.

When families have the right support from their service providers, they can learn how to implement appropriate care strategies. When parents and therapists work together as a team, then there will be success.

I can imagine that you have noticed differences between services & support to families provided in Florida compared to Ontario. What are some of the things that are done well in our province, and where do you see room for growth?

Coming back to Ontario, it’s been really encouraging to see that the space has been moving in the right direction. Especially in terms of the intent behind the new Ontario Autism Program (OAP), which looks to make support services more family-centered.  Everyone – including advocates, service providers, the community at large – is doing their best to help the countless families who need services. The effort to bring those services to families is there.

In my opinion, the most important improvement is to bring more clarity to the OAP. There are too many grey areas. What I mean is, it’s difficult for families to know exactly what they can and can’t get covered under the new program. It’s hard for families to know how to exercise their rights under the OAP, who to turn to for help, and how to get information about waitlists. It’s even hard for service providers to navigate the system. There needs to be more clarity for providers and families so that services can be provided seamlessly and ethically.

Call to action!

Sara John has a team of talented providers who are ready to provide services to families in the Greater Toronto Area. If you are a GTA family who is seeking a qualified ABA provider, send a message to Sara at sjohn@teampbs.com

Do you have an idea for a blog post that you’d like to share with Awake Labs? Send an email to paul@awakelabs.com with the subject line “New Blog Idea!”


Care with Uncompromising Integrity

Why is it important to provide care with uncompromising integrity? According to Christine, uncompromising integrity helps improve quality of life and sets people up for success all the way from childhood through to adulthood.

Christine is a mother, a BCBA, and an entrepreneur. She is pursuing her mission to provide the best support available to children with autism and their families by opening her own practice in the Seattle area. We had the chance to speak with Christine. We spoke about her philosophy of care, her first experience working with a BCBA, and the role of mental health support & technology in her practice.  

After a successful career spanning from New Mexico to Washington, you are about to open your own practice; congratulations!

Can you please share with us why it is important for you to open your own practice at this time, and what makes you most excited about this opportunity?

Since transitioning from public school to private practice, I have worked with some of the bravest and most incredible children and their families. The science of ABA opened up the opportunity to have an impact on the world, one person at a time. I’ve always been an optimist, a dreamer, and I am driven by the desire to have an impact. I am now opening my own practice so that I can do just that.

When I first began teaching, diagnostic rates were about 1 in 150. Diagnostic rates are now 1 in 59. In 20 years, 1 in every 59 young adults will have an autism diagnosis. At these rates, this is not a diagnosis that will affect just the individual and their family members, this will impact society as a whole.

Early, intensive intervention can change what that journey into adulthood looks like. It can help ensure that these future young adults have a skillset that allows them to be productive community members. Most importantly, it can help them have the best quality of life possible.

Some waitlists are up to two years in length for diagnosis and another 18 months for ABA therapy. Many families are often missing the critical window for early intervention, which is between 2-5 years of age. We need more BCBAs, more RBTs, and more agencies providing the highest quality of treatment available.

Opening my own agency will allow me to ensure that the families I serve are receiving the best treatment possible, and that it is delivered with uncompromising integrity. It allows me to continue to be a part of success stories, not only for my clients, but of the employees who are part of my team.

When you meet with families for the first time, what are some things you do to help them build trust in you as a therapist, and in the practice of ABA as a whole?

No two stories are the same. I’m a professional and parent of a child on the spectrum, and I have experienced challenging moments that seem insurmountable at times. Meeting a family with understanding and working together to identify the most important goals for their child are the first steps in building trust as a valued member of their child’s team.

One by one, families will begin to experience hard won successes like first words or calmer home routines. They will see their child light up to greet their clinical team. All this helps build trust in myself, the team, and the practice of ABA.

Family education and involvement are also key components of any good, trusted ABA program. As parents see what they feared was impossible for their child happening every day, as they witness the devotion, hard work, and joy of their clinical team, parents naturally become part of that team. Parents who are involved help bring consistency in all environments. This allows their child’s progress take on a remarkable trajectory.

ABA can dramatically increase the developmental trajectory of every client who receives it. It is truly remarkable to have a resource like this available. I always say that ABA is hard work, but it is heart work, so it makes it all worthwhile.

It’s an honor to work with children and their parents. I always keep that in mind, and strive to live up to that honor by providing the highest quality of care.

Thinking back on your first experience working with a BCBA, can you tell us what inspired you to follow that path yourself?

The first time I had the opportunity to collaborate with a BCBA, I was teaching a special education kindergarten class. One student was experiencing significant challenges and he was homeschooled while he went through a medication change. I had the opportunity to work with his ABA team during his home instruction.

My previous education and teaching experience had taught me to spend a significant amount of time focused only on behavior management. I learned that with ABA, the focus is on learning new skills with positive reinforcement serving as motivation.

I was in awe of the ABA team’s ability to motivate this student. His skill acquisition rates were very impressive. ABA methods allowed this child to make significant progress that I had not been able to achieve in the classroom.

The moment that truly inspired me to transition from teaching into clinical practice was when I observed this student interacting with his mom at the end of a session one day. Many parents of children with ASD often find themselves feeling overwhelmed with each task, which can have an impact on the whole family. This mom was able to calmly and effectively use ABA methodology to navigate daily tasks with her son.

At that moment I realized ABA was really about improving the quality of life not only for the child, but the whole family. That’s when I knew I had to follow this path.

Can you speak to the importance of addressing mental health challenges as part of your therapy?

An ASD diagnosis is rarely a single diagnosis. ADHD, Depression, Anxiety, and medical diagnosis such as epilepsy co-occur at a very high rate. Depression to the point of suicidal ideation and debilitating anxiety to the point of not leaving home is a common story I hear from parents of children with ASD.

It is imperative that ABA extends beyond early intervention, into adolescence and adulthood. The skills the learner needs to acquire change over the course of a lifetime, but the need for assistance may not. An effective ABA practitioner has an expanding repertoire of skills to address the diverse needs of their client. Acceptance and Commitment Therapy, and Relational Frame Theory offer excellent tools for our clients to successfully navigate mental health challenges.

Are there any innovations in technology that you think might help practitioners better address challenges in delivering care?

An ABA clinician should always consider themselves part of a larger team for all of their clients. Collaboration with other skilled clinicians such as SLPs, OTs, PTs, Medical and Psychiatric providers is imperative for true success.

One of the biggest challenges in this collaboration is effective communication. Communication between parents and all team members can ensure that critical daily information can be shared efficiently and make the difference between a challenging day or a successful day.

Each clinician is devoted to success of every one of their patients and coordinating care can be difficult with competing schedules. Technology allows opportunities for better continuity of care. Telehealth allows clinicians to remotely view another practitioner’s session with a shared client which can truly allow for the best co-treatment. Web-based data collection platforms offer the opportunity for real time viewing of data collection and sharing of these strategies and resources.

Technology can ensure that all private health information is securely stored and protected while allowing members of the clinical team to communicate and collaborate frequently and efficiently to better provide exceptional client care.  

Christine is looking for a partner!

Christine Domschot, BCBA, is opening her own clinical ABA practice in Seattle, WA – but she can’t do it alone. She is looking for a partner to join her and help grow her business. If there are any readers who are dedicated to ensuring that clinical integrity is never compromised, please reach out to Christine on LinkedIn.

Do you have an idea for a blog post that you’d like to share with Awake Labs? Send an email to paul@awakelabs.com with the subject line “New Blog Idea!”


Trust in Autism Therapy

We love talking to people who are passionate about their work. It’s even better when they share the same values as we do at Awake Labs. Jessica Reed, MA, BCBA was no exception. Jessica has an incredible story about why she became a BCBA. She shares her first experience with a young adolescent with autism and some tips on how to build trust in autism therapy.

From Corrections, to a Non-Profit, to Public School District

Jessica began her career by working in the education department of a prison in Idaho. She loved it and was completely inspired by her boss and mentor. By Jessica’s account, her boss was a “total badass” who dedicated her life to supporting survivors of sexual violence.

All signs pointed Jessica towards a career in the prison system. Unfortunately, 2008 came around and brought with it a sharp decline in public sector funding. This led Jessica to find work with a non-profit organization as a youth mental health specialist.

Jessica was assigned to provide in-home support to people with autism and their families. She loved this new role. After a few years, she reached a crossroads; the only way Jessica could grow her impact was to become a BCBA.

As a BCBA, Jessica worked in schools and felt the strong spirit of collaboration often seen in school-based teams. Inspired by this experience, she now provides ABA therapy and other positive behavior supports in public schools as the District Behavior Services Manager at Cabrillo Unified School District in California. 

Maintain Perspective: Jessica’s Advice for Aspiring Behavior Analysts

“The most important thing a young Behavior Analyst can have is perspective. As clinicians we are responsible for participating in families’ best and worst days of their lives. I feel so blessed to have been a part of huge milestones, such as when teenagers speak their first words, or when toddlers alert their parents to an ear infection for the first time. 

But I’ve also seen the grieving that parents experience when they realize that their child has difficulty making friends and is probably lonely. I’ve seen countless parents cry, worrying about who will care for their children when they no longer can. 

ABA has such a strong emphasis on collecting data, but we have to remember that the people we support are more than these data points. There’s nothing worse than walking into a session and seeing a practitioner’s face glued to their iPad, sidetracked by the need to record data, rather than react to what is in front of them. 

Compassion can go such a long way in this field.”

Going the extra mile for a nonverbal child

The first person with autism that Jessica worked with at the non-profit was a 12-year old boy. He was nonverbal and regularly showed severe aggression. Jessica did not feel prepared to support this boy and his family. The only “formal” training on autism she had received was watching a film about Temple Grandin.

Because of her dedication, it didn’t take long for Jessica to excel in her new role. She loved this family and their child. She even learned sign language on her own to better understand the person she was caring for. On weekends and after work, Jessica would also take any classes available to learn more about autism.

Professional Boundaries Protect Relationships With Students

According to Jessica, professional boundaries play a huge role in delivering care. When the lines are blurred, then personal trust and rapport can be built. However, the professional relationship is compromised. This can end up having a negative impact on the person at the centre of care.

Like the majority of people in this field, Jessica became a BCBA because of the emotional connection she felt with that first family. This is a feeling that extends to each new person she cares for. This connection may feel like a good path to friendship, but to be seen as a friend makes it difficult to say the things people don’t want to hear.

Both parents and professionals want what’s best for the person they support. But a professional has a different perspective that comes from their training. They also see things through a different lens because at the end of the day, the person they support is not their own child.

“Professional boundaries are important. When the boundaries get too blurred, it can affect the relationship with the student, which is such a sacred thing.”

Utilizing Trust, Compassion & Empathy

Educators and therapists do not deserve blind trust – trust is earned. According to Jessica, the best way to earn that trust is to show compassion and empathy. This is best illustrated in a story she shared:

“I have a students that I actually worked with in a previous job, in a private setting, so I would work with them in their home. There is a huge difference for this kiddo at home compared to school. They thrive at school, but struggle at home. 

Even though I know how hard the family fought for services, I actually made the recommendation to scale back the interventions at school. The student no longer needed them. This was hard for the parents to hear. So, in the IEP meeting, I held the mom’s hand and looked her in the eye. I told her that I had her back and that if anything changed, I would reinstate her kiddo’s behavior services. 

After the meeting, the mom followed me to the parking log, where she teared up and thanked me for this. I think it’s because I validated her experience and showed her that I could understand what she was going through. 

ABA can be such a black and white field, everything objective, measurable, observable. There is so much more to building trust than to know how people are reacting to their environment. Showing empathy goes a long way to bridging gaps, to moving away from being adversarial. Everybody has the same ultimate goal.”

Connect with Jessica!

Are there any aspiring behavior analysts interested in connecting with Jessica? You can find her on LinkedIn by clicking this link.  Introduce yourself and share with Jessica what you thought about this post!

Do you have an idea for a blog post that you’d like to share with Awake Labs? Send an email to paul@awakelabs.com with the subject line “New Blog Idea!”