Pairing: The Foundation of ABA Therapy

by admin | Feb 6, 2020 | ABA Therapy, Clinician's Corner, Provider

By Ellen Barnett, MA, BCBA, LBA

Pairing, or building rapport with a learner, is an essential component of ABA therapy. A positive relationship between the instructor and the learner sets the stage for successful ABA sessions and enables our clients to reach their optimal outcomes. Why then is pairing so often overlooked or not sufficiently implemented? In my experience as a supervisor, I have found that both instructors and parents may view pairing as unproductive play. Everyone is anxious for the “real” (re: structured and teacher-led) instruction to start!!! But pairing is just as important, maybe even more so, than all the programs we will eventually implement!!! Pairing develops the strong foundation upon which all good instruction is built. Without this strong foundation, we will not be effective providers of ABA therapy. Additionally, pairing never ends. Even after the foundation is built, we need to maintain it and keep it strong!!!

What is Pairing?

Very simply, pairing is the process by which you connect yourself (pair yourself) with all the learner’s favorite items and activities (reinforcers). Through these repeated connections, you take on the value of all the good stuff. You are now the ultimate reinforcer or the giver of all good things!!! If you take the time to pair with your learner, he will see you as he sees his favorite toys and activities. He will not only accept your presence, he will want to engage with you, and will be more likely to comply with instructional demands. Does your learner walk away from you or attempt to escape instruction frequently? If so, it’s time to pair!

How Do I Pair?

Pairing can be challenging. The following rules will help get you started and on your way to providing quality ABA therapy.

Rule 1: Have Fun!!!

If you are not enjoying yourself, odds are your learner isn’t either. Have fun and let your learner’s motivation lead the way. If he is lining up cars, join in!!! Start rolling the cars around and making fun sounds, “Vroom!” “Beep-Beep!” He may follow suit. If he likes Baby Shark, sing it often and get silly!!! Bounce and dance with him. Make Baby Shark more fun because you are part of it! Does your learner like the swings? Push him on the swing. Try tickling him while he’s on the swing, pushing him high in the air, or spinning him around. Make swinging more fun because you are part of it! Whatever your learner is interested in doing, join in and make it more fun because you are part of it! Feel free to introduce new ways of playing with the learner’s favorite items. Be enthusiastic, be playful, and embed lots of fun and smiles into your sessions!!!

Rule 2: No Turn-Offs!!!

What is a turn-off? A turn-off is anything you say which requires the learner to respond in a specific way. Do not make demands, give directions, or ask questions. Do narrate and comment. Instead of asking the question, “What color car do you have?” say, “You have a red car” or “I love playing cars!” What may seem like a harmless question to you, may feel like a pop quiz to your learner. Instead of directing the learner, “Look at my plane” or “Go fly the plane” say, “Wow, my plane is flying so high!” During pairing, there should be no requirements of any kind placed on the learner. The learner is allowed to access all his favorite items and activities for free!!!

Rule 3: Restrict Access to Reinforcers!!!

So things are going well and pairing is well underway. Your learner is running toward you and eager to engage with you. Now it’s time to restrict access to reinforcers. This means you will be in control of all reinforcing items/activities and your learner will be required to follow easy demands to access the items/activities. Now that you are familiar with your learner’s highly preferred items, bring a few of your own to the session. Odds are your learner will find the novel items appealing. Introduce an item. Once the learner demonstrates motivation, perhaps by reaching or pointing to the item, require an easy response before delivering that item. For instance, if you have a ball (and your learner is vocal), require him to say, “ball” before giving him the ball. Or, require the learner to “Sit down” before allowing access to the crayons you brought. This can work for a variety of activities. Maybe your learner likes when you lift him into the air. You can require him to first say, “Up.” Or, you can require your learner to “Give me five” before getting the tickles he enjoys. Remember to keep your demands simple so that your learner can easily access his reinforcers.

Rule 4: Play Starts With You and Stays With You!!!

Start engaging your learner in the area you plan to do most of your instruction. Make the instructional area more fun and exciting than any other area in the learner’s environment. Do this by limiting access to reinforcement outside of the instructional area. When the learner is with you in the instructional area, he gets bubbles, tickles, music, piggyback rides, etc. These reinforcers disappear when the learner opts to leave the instructional area. But they come back as soon as he returns. If the reinforcer is a toy, make certain your learner does not remove it from the instructional area. Perhaps you have brought a MagnaDoodle and your learner cannot get enough of it. You are ooohing and aaahing as your learner scribbles when he decides to take the MagnaDoodle to another room. Let the learner know he is free to go to another room, but the MagnaDoodle stays with you. By doing this, you set up yourself and the instructional area as the learner’s most reinforcing option. Your learner’s choice should be reinforcement with you or no reinforcement at all.

Pairing Never Ends!

There is no timetable, schedule, or formula for pairing. It may take a few hours, a few days, or a few weeks, depending on the learner. But once you have determined that you are sufficiently paired with your learner, do not stop pairing!!! Pairing should be built into every session of ABA therapy. Pair at the top of your sessions; pair before task demands; pair toward the end of your sessions. In other words, embed pairing into all your sessions. Alternate pairing and instruction (leaning more heavily on pairing) so that the learner will not be able to differentiate between the two. This ensures that your learner will want to stay with you for longer and longer periods of time. This increases the likelihood that your learner will choose to engage with you and comply with your directions. Ultimately, this builds the positive rapport needed to foster a healthy therapeutic environment where new skills are learned.

Are you interested in joining the Attentive Behavior Care team? Apply today!

Importance of Self-Study in the Field of Behavior Analysis

by admin | Jan 9, 2020 | ABA Therapy, Clinician's Corner, Provider

By: Gabrielle Galto, MS, BCBA, NYS LBA

In many fields it is important, even required to partake in continuing education courses. I believe in order to be successful and grow as a professional it is necessary to have a scholar-practitioner outlook; meaning, even after obtaining your degree it is important to continue to seek learning opportunities and educational growth as a practitioner.

Of course, it is also a requirement within the field of applied behavior analysis (ABA) as both a Board-Certified Behavior Analyst (BCBA) and Board-Certified Assistant Behavior Analyst (BCaBA). Therefore, it is not only necessary but essential to maintaining one’s credentials. Unfortunately, this does not mean that practitioners within the field see the importance of continuing education courses or engage in self-study, which is the main focus of what I would like to speak upon.

What is Self-Study?

Self-study, what is it exactly? Does it include continuing education courses? Definitely! But isn’t it really just studying by yourself, well maybe? But I believe it is more than that. I believe that within our practice it is important to engage in not just what is required, but truly go out and seek opportunities to learn. As a scholar-practitioner some ways to engage in self-study can include partaking in relevant webinars, studying texts from previous courses, conducting literature reviews, and reading up on new studies and findings within the field of behavior analysis, which is very important within our growing field! Self-study can go a step further by taking a closer look into the subject or area you are learning. Truly becoming not just a researcher but your own teacher. This can be such a huge advantage as a clinician to ensure the most appropriate and individualized interventions are provided, expanding our skills and competence on a more daily basis can further reinforce past knowledge through daily practice.

Self-study is a way of learning without relying on others to directly teach or train as a way to strengthen one’s own knowledge. For example, when working with a client you hold the credentials and are competent with the areas required, however notice a lack of progress and decide to conduct a literature review within the past 5 years. When doing so you learn a more effective, empirically evidenced based intervention package, opposed to the same cookie-cutter techniques typically used. This can then lead to teaching oneself how to set up the intervention package, train your technicians or practitioners on the specific strategies and finally apply the new treatment plan with your client. Self-study is not just more convenient but a practical way for a clinician to learn new or improve one’s skills at a much faster rate than other methods. It is not to say that a more structured way of learning will never be needed. For ethical reasons it could be required for a clinician to seek out further support or training when expertise is needed in order to become competent. Nevertheless, as a professional engaging in self-study prior to seeking additional support from other colleagues can exemplify initiative as a resourceful and self-driven professional.

Implementing the Technique

Make sure that prior to implementing any technique, strategy or behavior change procedure that you follow the BACB ethical guidelines, which could be a whole other blog post in and of itself! Applying new strategies, findings, and techniques can further provide our clients with the most successful outcomes.

The opposing outlook of only doing the bear minimum, which I assume if you are reading this then you are already part of the other side who are self-driving and motivated to grow within the field! Which I love! Congratulations! Anyway, back to my point on if you are a part of those that only get just enough CEU’s and barely sit through the lectures without scrolling on your phone or falling asleep. As a professional within the field of behavior analysis, doing so will only hurt you in the long run.

It is clear that our field continues to grow in and of itself with new research findings, intervention packages, and evidenced based practices. Where if you feel that you do not need to engage in self-study this can lead to a very tunnel vision mindset, one that may not be able to see the bigger picture or implement a different strategy than the one you were trained on 10 years ago. I am not saying I am perfect. I have had cases that I thought I had the answers, I knew exactly what needed to be done without question and when it didn’t work I was completely stunned. In those moments it was hard to think of any next steps as I was in such disarray, which is a huge hindrance for any clinician. Imagine if we never engaged in self-study, we could continue to be providing hot sauce to patients as a punishment procedure opposed to incorporating the most recent empirically validated treatment plans.

Behavior intervention plans may be created based only on topography and not function or including functional alternatives. These are all an exaggeration of course, but it is clear that self-study is important based on how it can expand our knowledge and practice as well as lead to future research within our ever expanding field of behavior analysis!

Are you interested in joining the Attentive Behavior Care team? Apply for a position today!

The Role of Trial Based Functional Analysis (TBFA) in ABA Therapy

by admin | Dec 26, 2019 | ABA Therapy, Clinician's Corner, Provider

What is Trial Based Functional Analysis (TBFA)?

The Trial Based Functional Analysis, a relatively new form of assessment, was created to combat these difficulties by offering a fast and inexpensive form of assessment that informs behavior plan implementation. Rather than requiring 20+ minute conditions per each individual condition, two minute conditions that rapidly alternate are implemented in a pairwise fashion that are used to evaluate the potential antecedents and consequences that contribute to the initiation and ongoing maintenance of a targeted behavior. Using a control-test-control-control format, each analogous “condition” takes approximately six minutes to complete resulting in approximately ten conditions per hour of direct analysis which could potentially result in an interpretable result. Conditions are terminated after a single instance of the target behavior following delivery of the reinforcer being assessed. These probe data are usually presented as percentage of trials with problem behavior but have recently been analyzed using equal interval graphs (Bloom et al., 2013).

The current literature has validated this assessment using the Litmus Test (i.e., using reduction in problem behavior when interventions are based on the function derived in the assessment) and by comparing results from analog assessments (Austin, Groves, Reynish, & Francis, 2015). These two forms of validation have resulted in very different conclusions. Comparing the TBFA to standard analog assessments has resulted in an approximate 60% match (Austin et al. 2015). Those validating using the Litmus Test have found a near 100% validation rate (Bloom, Labmert, Dayton & Samaha, 2013; Kodak, Fisher, Paden, & Dickens, 2013; Lambert, Bloom, & Irvin, 2012). Studies using the Litmus Test have incorporated multiple baseline across participant designs, which add to the internal validity of their claims, but do not account for this discrepancy.

Understanding the Current Limitations of TBFA

So that’s fantastic: when we build a behavior plan off of the TBFA it works. However, the discrepancy between analog and alternative methods exists in a fairly significant chasm. Very little literature has been conducted in an attempt to determine why this discrepancy exists. Hypotheses abound ranging from lack of experience or training with the assessment method to failure of conditional discrimination or that the TBFA is simply an inferior form of analysis when compared to the analog. The questions abound but with such limited data and research it is difficult to make proper assertions.

The problem here: we simply do not have the research yet to back up any claims! We have emerging evidence but nothing that truly compares apples to apples the differences between the assessment methods to make a truly informed decision regarding clinical utility. As the great Dylan Thomas once said: “do not go gentle into that good night.” Research on, my fellow nerds!

References:

• Austin, J. L., Groves, E. A., Reynish, L.C., & Francis, L. L. (2015). Validating Trial Based Functional Analyses in Mainstream Primary School Classrooms. Journal of Applied Behavior Analysis (48)2, 274-288.
• Bloom., S. E., Lambert, J. M., Dayton, E., & Samaha, A.L. (2013). Teacher Conducted Trial- Based Functional Analyses as the Basis for Intervention. Journal of Applied Behavior Analysis 46(1), 208-218.
• Hanley, G.P. (2012). Functional Assessment of Problem Behavior: Dispelling Myths, Overcoming Implementation Obstacles, and Developing New Lore. Behavior Analysis in Practice 5(1), 54-72.
• Harvey, C.A., Harvey, M.T., Kenkel, M.B., & Russo, D. C. (2010). Funding of applied behavior analysis services: Current status and growing opportunities. Psychological Services, 7(3), 202-212.
• Kodak, T., Fisher, W.W., Paden, A., & Dickes, N. (2013). Evaluation of the Utility of a Discrete Trial Functional Analysis in Early Intervention Classrooms. Journal of Applied Behavior Analysis 46(1), 301-306.
• Lambert, J.M., Bloom, S.E., & Irvin, J. (2012). Trial-Based Functional Analysis and Functional Communication Training in an Early Childhood Setting. Journal of Applied Behavior Analysis 45(3), 579-584.

Are you interested in joining the Attentive Behavior Care team? Apply today!

How to Increase Skill Development and Reduce Inappropriate Behaviors

by admin | Nov 28, 2019 | ABA Therapy, Clinician's Corner, Provider

By: Deirdre Kozyrski, MS, BCBA, LBA

In providing ABA services to individuals with a diagnosis of autism, proactive strategies are often used to help our clients gain critical language, social & self-help skills and reduce inappropriate and/or behaviors of concern. A proactive strategy is used before a behavior of concern occurs to help prevent that behavior from occurring. One such proactive strategy is the use of social stories. This article will focus on the following aspects of social stories.

1. What are social stories?
2. What skills can they help teach?
3. Has there been research on the effectiveness of social stories?
4. How can social stories be implemented in home- based ABA treatment?

Social stories are great tools to help to prepare people with the diagnosis of autism for new settings and for learning new skills. Social stories are written stories that provide information about a specific topic/setting. They can also provide some instruction on choices of appropriate behaviors that can occur within that topic/setting. Social stories can be used with all different ages, being able to read is not a requirement. For those clients who do not read, a social story could be read to them. Social stories often have pictures in them to help increase understanding of the topic, but do not have to have pictures/photos. The length of a social story often depends upon the age and skill level of the reader.

Guidelines of a how social story is written can vary depending upon the author. Social stories are often written in the first or third person. For example, a first – person sentence is “I am going to the beach with my family”. An example of a third person sentence is “Some families go to the beach for their vacation”. In her book, The New Social Story™ Book, 2015, Carol Gray describes 10 components of a Social Story™. (When the words Social Story™ are capitalized that is indicative that the story meets all of the Gray’s current 10.1 criteria). She also includes a CD in this book that has printable Social Stories™ that can be edited to meet a reader’s individual needs.

Carol Gray initiated the use of the Social Story™ approach approximately 30 years ago. In her 2015 book, she describes using both descriptive sentences and coaching sentences in a Social Story™. A descriptive sentence provides information about a topic without any kind of judgement or opinion. A coaching sentence offers choices of appropriate words or actions that could be used in the specific setting or situation. Throughout her book, Gray emphasizes the importance of respecting the intended readers. Aligning with that respect is her dedication to using positive statements in a Social Story™. She also suggests including sentences about the reader’s strengths & accomplishments in the Social Story.™

There are thousands of topics that can be written about in a social story. Here are some topics that I have helpful with my clients:

1. ADL /Safety Skills – Learning how to : tie shoes, brush teeth, safely take medicine, take a shower, get dressed/undressed in a private setting, brush hair, accept getting a hair – cut without a tantrum, safely cross a street, safely walk through a parking lot, safely use a pool, appropriately interact with the family cat, etc.
2. Social Skills – Learning how to: acclimate to a new school, how to play on the school playground, how to order lunch in the lunch room, go to the supermarket with your parents, go through security at the airport, use safe behaviors while on a family vacation, take turns with peers for choices of games/activities, eat at a restaurant, etc.
3. Communication Skills – Learning how to: ask a peer to play, what can be said if that peer says “no”, ask for help, etc. Learning about the choices one can say when: a game is lost, a game is won, when a food is disliked, when a gift is disliked, feeling frustrated, angry, etc.

Some research that have been done on the effectiveness of Social Stories™ are:

1. Thiemann & Goldstein (2001) combined the use of social stories with written text cues and video feedback to improve specific social communication skills ( contingent responses, securing attention, initiating comments and initiating requests) in 5 students with diagnoses of autism. They used Carol Gray’s 1995 criteria for social stories. Comprehension questions were also used after the reading of the social stories. A 10 minute social interaction time with typical peers was implemented after the instructional phase ( reading of the social story, comprehension questions & practice written text cue cards). This social interaction time had a specific social goal. The interaction times were video recorded and the 5 students were able to view their interactions. Students checked off on a yes/no form if they saw themselves demonstrating the specific social goal. The results of this study determined the combined treatment package did in fact increase the above specific communication skills.
2. Chan & O’Reilly ( 2008) used Social Stories™ in an intervention package for 2 students with diagnoses of autism who were in a kindergarten inclusion classroom. The Social Stories™ were written using Carol Gray’s 1995 criteria. The reading of Social Stories™ were followed with comprehension questions and role play. The specific social communication skills targeted during this study were : increase in appropriate hand raising, increase in appropriate social initiations, decrease in inappropriate social interactions (personal space difficulties) and decrease in inappropriate vocalizations. The results of the study were increased appropriate social communications skills and decreased inappropriate social communication skills for both students.

Based on the above research, I have found it helpful to implement social stories/Social Stories™in combination with both comprehension questions and role play in home-based ABA treatments. I have also found it helpful to involve the parents of the client in the creation of the story by asking them to provide details of the topic/setting. Parents also are a great resource for providing pictures/photos for the story. Once we have the details of the story, I can ask the parents to provide specific photos that will help clarify the information in the story.

If a client is going on a family vacation, I usually start using the story in the client’s sessions at least 1 month before the vacation. I also ask the parents to read the story to the client a few times a week before the vacation and to take the story with them on vacation for further review. During the client’s session, I usually include 3-4 comprehension questions regarding the story in his/her program. I have found the client’s answers to the comprehension questions to be helpful in determining on how many times a social story needs to be read/reviewed. If the client continues to have difficulty correctly answering the questions, the story probably needs to be modified. After the comprehension questions have been discussed, we start to role play the targeted skills of the story.

Depending upon the topic/skills being learned and the age of the client, role play can be done with stuffed animals/dolls or with the client and team members. For example, with a 6-year old client learning how to accept taking medication without tantrumming, we role play with stuffed animals/dolls who are “sick or injured” and need to take “pretend medicine”. For an 8 -year old client who is going on a family vacation that requires him to go through airport security, we set up a mock security station with him and other team members in his home. He practices putting his belongings in a bin and walking through a mock metal detector. We practice different potential scenarios – the metal detector going off and the client having to walk back through it again, the metal detector not going off, etc.

Social Stories™ /social stories have been implemented as part of proactive interventions to help increase socially significant skills in people diagnosed with Autism. Many skills can be introduced through these stories. If you would like more information about this topic, please refer to a review of literature by Karel & Wolfe (2018).

Additional Resources:

• https://carolgraysocialstories.com/

References:

• Chan, J.M., & O’Reilly, M.F. (2008). A Social Stories™ Intervention Package for Students with Autism in Inclusive Classroom Settings. Journal of Applied Behavior Analysis, 41, 405-409.
• Gray, C. (2015) The New Social Story™ Book, 15th Anniversary Edition. Arlington, TX: Future Horizons.
• Karal, M.A., & Wolfe, P.S. (2018). Social Story Effectiveness on Social Interaction for Students with Autism: A Review of the Literature. Education and Training in Autism and Developmental Disabilities, 53(1), 44-58.
• Thiemann, K.S. & Goldstein, H. (2001). Social Stories, Written text Cues, and Video Feedback: Effects on Social Communication of Children with Autism. Journal of Applied Behavior Analysis, 34, 425-446.

Are you interested in joining the Attentive Behavior Care team? Apply today!

What Jobs Can You Get With a Behavior Analysis Degree?

by admin | Jul 11, 2019 | ABA Therapy, Clinician's Corner, Provider

By: Jacob Papazian MS, BCBA – Regional Clinical Director, Michigan

Applied Behavior Analysis (ABA) is most commonly associated with intensive intervention for developmental disabilities. A quick search on Indeed.com in the Southeast Michigan area brought up 12 different companies asking for Board Certified Behavior Analysts to work with individuals diagnosed with Autism Spectrum Disorder (ASD) and one lecturer position for a university.

This is not terribly surprising considering that the highest proportion of the Behavior Analytic literature has focused on treating behavior disorders (Leblanc, Heinicke, & Baker, 2012).

What Jobs Can I Get With a Behavior Analysis Degree?

Despite the popularity, there are a variety of career avenues available to Behavior Analysts that have nothing to do with developmental disabilities. In this post we’ll be discussing 7 fantastic jobs that you can get with your behavior analysis degree.

1 – Clinical Behavior Analysis

Behavior Analysts have long been overlooked in the turf war that is psychotherapy. Psychologists, social workers and counselors are trained to shape verbal behavior in sessions to bring about changes with a heavy focus on emotions and internal events. Psychotherapy has evolved with manualized treatment that is behavioral in orientation. If you have the inclination to use self-reporting as a form of data collection and a thirst for Relational Frame Theory (Ruiz, 2018), then Clinical Behavior Analysis may be for you! Most states require a Ph.D. in Clinical Psychology or a similar terminal degree to perform and be reimbursed for psychotherapeutic services. However, several states allow Masters level clinicians to practice under the supervision of a Ph.D. Potential placements can include hospitals, schools, and private practices. Literature has been published in a variety of areas including personality disorders, depression/anxiety, psychosis spectrum, and obsessive compulsive disorders (formally under the umbrella of anxiety disorders).

2 – Clinical Research and Education

Are you a super nerd that has a passion for teaching?

Are you always reading the newest journal articles or dreaming of the next big research project for your clinical team?

If that is the case then you should consider a clinical research and teaching position with a local university. Many universities are offering coursework online and seek out Master’s level instructors. The advantage of having lecturers in their programs are twofold: they are typically less expensive than the core faculty and offer students an opportunity to learn from clinicians that are actively practicing. Research requirements are typically less intensive but offer resources most clinics do not have available.

3 – Comparative Animal Behavior

If you, like me, are a Disney fanatic and love animals, then there is the perfect job for you with the mouse! The Walt Disney Company hires Behavior Analysts that have experience with animal behavior. When new animals are introduced to the safari, they are taught to return to their night enclosures using conditional discrimination. Recreation specialists use phylogenically appropriate activities to keep the animals entertained and healthy. Most importantly, animal training occurs regularly for the wildlife shows throughout the parks to promote a message of conservation.

4 – Organizational Behavior Management

If working with neurotypical individuals is more your style, working in Organizational Behavior Management (OBM) might be a good fit for you. OBM practitioners typically work as independent contractors for companies to improve some aspect of performance through a variety of activities including functional assessments, interviews, and corporate trainings. Human Resources staff and recruiting also find that Behavior Analysts are great fits based on their understanding of motivation. Does helping the Olive Garden reduce food waste or increasing the average sale for a local pet supplies store sound interesting? How about helping managers become effective leaders? If so, OBM is a great option.

5 – Environmental Preservation

If the idea of protecting the planet is important to you then working in Environmental Preservation might be a good idea. Eco-friendly companies are always looking for specialists to not only market their products but to entice consumers to actually use them. Other organizations have been using Behavior Analysts in more traditional retail environments to increase use of biodegradable products. For example, researchers have recently been using extra stimulus prompts to reduce single-use plastics in restaurants with moderate success. For those that are interested in working in environmental policy this is a must consider.

6 – Theme/Amusement Park Safety and Security

Have you ever noticed that in theme and amusement parks, you feel relatively safe? So safe that you spend money on merchandise and food that you would normally never buy? There is an entire science behind keeping guests immersed and feeling safe to maximize spending. Behavior Analysts can provide valuable insight into the motivating operations to engage in target behaviors while in theme parks such as buying merchandise/food products and helping improve traffic flow to improve safety. Those that buy annual passes to their favorite attractions should look into these types of opportunities for free park admission and a paycheck!

7 – Health and Fitness

If you have been watching reality television shows lately, you may have noticed a small uptick in the realm of “life coaching.” Individuals are claiming to be “coaches” to improve quality of life. In most cases their goals center on health, fitness, and wellness. However, most of these individuals are not certified or licensed to be doing such work. Behavior Analysts are a logical fit to help consumers increase the frequency of engaging in healthy behaviors such as increasing cardiovascular exercise and reducing consumption of processed foods. Literature demonstrating the efficacy of basic behavior modification techniques to aid in weight loss is abundant. This specialization does warrants collaboration with other professionals such as dieticians, medical doctors and sports psychologists to ensure that clients are healthy enough for the activities and that they have an adequate caloric intake (Martin, 2015).

Regardless of the path that you take as a career, it is important to remember our ethical guidelines. As Behavior Analysts we stay within our competency. If you are interested in gaining more experience in an area, find a supervisor that can oversee your work and provide you additional support when needed.

What if I Like Developmental Disabilities?

If you have read up to this point and still are thinking “but I like what I do. I like working with Autism” then you are not alone. Working with ASD/DD is a lucrative option that has such a significant impact on the lives of those with which you work. As awareness increases, so do the opportunities for BCBAs ranging from direct care to clinical leadership. Attentive Behavior Care is one such organization that offers positions from technician to executive clinical leadership stressing clinical excellence.

Are you interested in joining the Attentive Behavior Care team? Apply today!

References:

• LeBlanc L. A., Heinicke M. R., Baker J. C. (2012). Expanding the consumer base for behavior-analytic services: meeting the needs of consumers in the 21st century. Behavior Analysis in Practice, 5, 4-14.
• Martin, J. (2015). Behavior analysis sport and exercise psychology. Behavior Analysis: Research and Practice, 15(2), 148-151.
• Ruiz, F. (2018). A multiple-baseline evaluation of a brief acceptance and commitment therapy protocol focused on repetitive negative thinking for moderate emotional disorders. Journal of Contextual Behavioral Science, 9, 1-14.

“What Next?” – When Your Treatment Plan Doesn’t Work

by admin | Jun 20, 2019 | ABA Therapy, Clinician's Corner, Provider

By: Jonelle Lupero, MsEd, BCBA, LBA (NY)

Note: The following is a fictional vignette created for the purposes of demonstrating common situations encountered by professionals in this field.

Every week, I meet with a fellow Board Certified Behavior Analyst (BCBA®), “Lauren,” my supervisee who has been working in the field as a BCBA® for almost one year, is currently earning her supervision hours and working towards licensure as a behavior analyst in New York State. We have weekly meetings where I give her feedback about specific clients, treatment plans, and anything else pertinent that she would like to speak about. Recently, we have been conversing about her patient, “Julie,” a non-vocal 7 year old girl with Autism Spectrum Disorder (ASD). Lauren supervises Julie’s home-based ABA therapy program. Recently, Lauren has been expressing frustration about the way treatment sessions have been going. This week the conversation went like this:

Me: “Hi Lauren! How have the sessions been going with Julie?”

Lauren: “Ugh. I am super frustrated; I feel like I have tried everything! Julie is not making progress on her treatment plan goals”

Me: “So let’s take a few steps back. What specifically is the major issue you are dealing with?”

Lauren: “After working for 30 minutes, Julie earns a break. Every single time she goes on her break, she has a severe temper tantrum.”

Me: “Is she requesting a break?”

Lauren: “No, she has a very limited mand repertoire. We are working on shaping her mands now.”

Me: “What are her reinforcers?”

Lauren: “M&M’s, IPAD, break.”

Me: “When did you conduct the last preference assessment? Did you conduct a reinforcer assessment?”

Lauren: “I haven’t.”

Me: “So how do you know that the “break” is a reinforcer for her?”

Lauren: “It states it in the initial assessment.”

Me: “What are the dates of the assessment?”

Lauren: “It’s from almost one year ago.”

Me: “So how do you know that the break is still a reinforcer for her?”

Lauren: “It states it in the report.”

Me: “Sometimes we need to reassess. Just because a break might have been reinforcing for her one year ago doesn’t mean that it is a reinforcer for her now.”

Lauren: “Do you think that is why she is having temper tantrums?”

Me: “It could be; perhaps she doesn’t want the break.”

Lauren: “So what are my next steps?”

Me: “First, you need to conduct a preference assessment to see what things might function as reinforcers for Julie.”

Lauren: “Okay.”

Me: “Then, I would test it out. Conduct a session using the suspected reinforcers that you identified during your preference assessment. This will help you determine if these “preferred” stimuli will actually function as reinforcers for Julie. In other words, does the presentation of these stimuli actually result in an increase in the future frequency of the behavior that preceded it?”

Lauren: “Okay.”

Me: “Let’s see how that goes first and then we will discuss the results the next time we meet.”
Lauren: “Okay. Thank you for your feedback.”

In ABA therapy, or any other type of therapy for that matter, it is true that sometimes treatment plans simply do not work out as planned. Problem behavior may increase, and the individual may not make progress with the specific treatment goals.

The great news for individuals receiving ABA therapy is that BCBAs® are perfectly equipped and trained to deal with this. ABA is a science, and because of that, the data guides our decision making. All of the data recorded during each session will be carefully analyzed on a regular basis so that the BCBA® can make immediate changes to the treatment plan when the outcomes aren’t what we expect.

Since data are recorded and analyzed constantly, an ineffective treatment plan will not stay in place for long. In fact, one of the 7 dimensions of ABA is that it is effective—therefore, if the treatment plan isn’t effective, it means that ABA is not being done correctly, and the treatment must be monitored and adjusted until there is a positive impact on the target behavior.

So, what can we do when this happens? The previous scenario is one example regarding what we can do when our treatment plan isn’t working the way it was planned: reach out to a colleague… (of course protecting PHI)

Here are some other recommendations:

• Revisit the original assessment. When was it done? What are the behaviors targeted for increase? What are the behaviors targeted for decrease? Does it match the client’s deficits now?
• Revisit the FBA/BIP. Does the FBA/BIP need to be updated? Do the interventions being implemented match the functions of the behaviors?
• Is there treatment integrity? Is the treatment plan being implemented the way it was intended?
• Are the patient’s reinforcers updated? When was the last preference assessment done? Was a reinforcer assessment conducted following a preference assessment?
• Communication. Is everybody on the team communicating including parents, technicians, and the BCBA®?
• Is parent training taking place? Have there been any significant changes in the individual’s life (e.g. moving, new sibling, change in school)?
• Coordinate care. Did you coordinate care with other professionals who work with the individual? Is the individual on any medications? Are there any medical conditions or limitations you should account for? Are multiple treatments being implemented?
• Collaborate with a fellow BCBA®. The field of ABA is very big and not one person knows everything!
• Do the research! There is a vast amount of resources available to us including “ABAI”, Association for Applied Behavior Analysis International, “BACB”, Behavior Analyst Certification Board, JABA (Journal of Applied Behavior Analysis) and many more!
• Consistency, Is the individual receiving the recommended frequency and duration of ABA therapy? Do adjustments need to be made to the schedule?

As a behavior analyst we have many options when our treatment plans are not working. I hope you found this information useful and can implement some of these recommendations.

Are you interested in joining the Attentive Behavior Care team? Apply today!

Better Understanding Your Job as a Board Certified Behavior Analyst

by admin | Jun 13, 2019 | ABA Therapy, Clinician's Corner, Provider

By: Maria Pantelides, MA, BCBA, LBA (CT, MA, MD, NY)

You have finished your coursework, you’ve completed all of your supervision hours and passed the BACB Exam, CONGRATULATIONS!

Behavior analysis is the science of behavior. Behavior is a product of its circumstances, particularly the event that immediately follow the behavior. (The Board Certified Behavior Analyst® (BCBA®), 2019).

In the role as a behavior analyst, you study behavior and how that behavior affects motivation. Our goal as behavior analysts is to improve the lives of the individuals and those who care for those individuals. Applied Behavior Analysis (ABA) “is a scientific approach for discovering environmental variable that reliably influence socially significant behavior and for developing a technology of behavior change that takes practical advantage of those discoveries” (Cooper et. al, 2007).

By utilizing the principles of ABA our goal is to provide the highest quality services possible to our clients, and increase socially important behaviors. There are various environments you can work as a behavior analyst (e.g., schools, homes, clinics, hospitals); regardless of the environment you are working it is important that every client has an effective treatment that is rooted in the evidence-based literature of ABA.

Often times, as a behavior analyst you spend an extensive amount of time working with other professionals (e.g., technicians, parent/caregivers). These individuals also work with the client and implement treatment that you have created. It is your responsibility to analyze the data, and be present as a BCBA in the client’s program and ensure that you are providing an effective treatment. We are constantly communicating with parents and other team members of our clients and in your role as a behavior analyst, it is important to remember that collaboration and consistency is critical to the success of your client.

As a behavior analyst you must be able to provide services that are within your scope of practice and area of expertise. You must abide by Behavior Analyst Certification Board’s Professional Ethical Compliance Code and Guidelines for Responsible Conduct (BACB, 2014) as well as all local, state, and federal laws with regards to the provision of services.

A behavior analyst plays a huge role in an individual’s team and can help decrease the challenges faced, enhance the lives of individuals, and increase an individual’s quality of life as well as their families. The field of ABA is constantly growing and there is always new research being conducted on how to improve our client’s socially significant behavior. There is no better job or field than that!

References

• Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers (2014, Behavior Analyst Certification Board Inc.(“BACB) Ver 2.0). Retrieved from http://bacb.com/wp-content/uploads/2016/08/ABA_Guidelines_for_ASD.pdf
• Behavior Analyst Certification Board Professional and Ethical Compliance Code for Behavior Analysts(2014,
• Behavior Analyst Certification Board, Inc. “BACB”). Retrieved from http://bacb.com/wp-content/uploads/2016/03/160321-compliance-code-english.pdf
• Cooper, J.O., Heron, T.E., & Heward W.L.,(2007). Applied behavior analysis (2nd ed.).
  Columbus. OH: Merrill Prentice Hall.

Why I Love Working at Attentive Behavior Care

by admin | Apr 18, 2019 | ABA Therapy, Clinician's Corner, Provider

By: Jessica Basir, M.S., BCBA, LBA (NY, CT)

If you are reading this post, chances are you are pursuing an ABA therapy job. You may have a lot of experience working in the field, or you even have your BCBA®. Maybe you are just beginning your journey in this field and have no experience at all. Either way, deciding on a job in the field of ABA therapy can be overwhelming since there are a multitude of options out there.

So, how do you choose?

You already made the first step by checking out our website and doing some research!

First and foremost, many individuals who work for Attentive Behavior Care (ABC) grew their careers within the company. Current full-time BCBA’s® began their careers working part-time with ABC as technicians on one or two cases.

As their interest grew in the field, they began pursuing their education in ABA, obtaining their degrees, and becoming Board Certified Behavior Analysts®. From there, they pursued their career goals with the help of the clinical team and obtained full-time positions as supervisors overseeing a multitude of cases. ABC helps grow professionals and fosters long-term professional goals.

Working at ABC

ABC has been recognized as a Behavioral Health Center of Excellence since 2016 and was recently awarded a two-year re-accreditation from the BHCOE. This award recognizes the company’s integrity and the effectiveness of the services they provide. Working for a company that achieves substantial recognition in our field provides a great sense of pride and admiration from the employees who work within it. At ABC, you can be proud of where you work.

Working within ABC you will also have access to top-of-the-line data collection systems and virtual clinics. Rather than completing data on paper, fussing with clipboards, and managing a multitude of program sheets, all data is stored in a virtual database allowing for easy access of all programs, targets, and data collection procedures. You do not have to worry about forgetting anything because it is all at your fingertips! ABC also provides all staff with their own personal company tablets, and an on-site training team to assist with any difficulties you may have.

ABC’s Support Teams

Another great asset of ABC is their support teams. Whether you are a technician starting your first case, or a BCBA® who has been in the field for years, the science of ABA therapy requires an extensive amount of collaboration. ABC provides each case with a case coordinator, an individual assigned to help maintain schedules, consents, and communication between families and their staff. In addition to the coordination staff, the offices consist of a clinical director who is assigned to help collaborate and respond to clinical questions concerning your specific cases.

ABC also offers part-time and full-time opportunities, in multiple states. Schedules are tailored to your preference in location, times, and skill level. Similarly, the company fosters an environment that allows individuals to grow and pursue their long-term career goals from start to finish.

Whether you are just beginning your journey or are a seasoned professional in the field of ABA therapy, ABC will support you on your journey to growing your skills and offer you experiences that will last a lifetime.

That is why I love working at ABC!

Are you interested in joining the Attentive Behavior Care team? Apply today!

The #1 Question Everyone in ABA Therapy Should Know How to Answer

by admin | Mar 14, 2019 | ABA Therapy, Clinician's Corner, Provider

By: Heyde Ramirez, MA, BCBA, LBA

Am I Making a Difference?

Congratulations! You are officially a Board Certified Behavior Analyst® (BCBA®). The day has finally come, and you’ve been handed your first case. You are excited! After all, imagine all of the possibilities. All of the potential behaviors to shape, increase, and decrease. You have trained for this and you can’t wait. You want above all else to make a difference!

You go and meet your client and their family for the first time. You are professional and courteous. You conduct a skills assessment and go home and develop goals. You are giving this case your all, as you should, and you find yourself devouring the research, ensuring that all of your treatment techniques align with what we know to be evidenced based practice. You create the data sheets. You gather your materials. You feel good, right? A sense of accomplishment that comes with knowing that you are about to change someone’s life envelopes you. You are the team captain, and you have gathered the finest crew available. You have plans to provide ongoing training to the behavior technicians and to your client’s family. You know exactly what to do and where to go as you make plans to lead your team on an expedition that will no doubt take your client on a journey towards independence and a higher quality of life. But are you REALLY making a difference? How do you even begin to answer that question?

Find Out From Others

Well, it’s not the kind of question you can or should answer on your own. Talk to the team, remember, while you may be the BCBA® on this case, you are just one part of this team. Sure, you’ve trained for this and you believe you know what your client needs most, but ultimately you are there to provide a service to your client. Is your client and their family going to be happy with the service rendered? Families have sought out ABA therapy in most instances in order to see the life of their loved ones improved. They want to see a difference. So how do you make that difference? You may have a treatment plan with beautifully written long and short term goals, but are they socially valid?

Social Validity is Everything!

What is social validity? Well plainly put, does anyone care about what you are teaching your client to do? Is it going to better their quality of life? Is the family on board with the goals in the treatment plan and how you plan to achieve those goals? Were the results noteworthy? If social validity is low…well… let’s just say… you may not be making that difference in people’s lives that you strive to make. Social validity is like that secret ingredient of that dish you love so much, and without it, no one is really going to want to go back for seconds.

As a BCBA®, you are in an amazing position, armed with powerful behavior altering tools, and within reason there is probably nothing you can’t train. Be sure to never stop asking yourself if you are making a difference. Be the BCBA® who stops and truly listens for that answer. Whenever possible, ask your client what they want to work on, and when that isn’t possible, rely on trusted caregivers to give you as much information as possible. Use evidence based practices and ensure buy-in from the team.

Remember, treatment plans should be individualized to the client and that includes the treatment techniques used during treatment. Be the BCBA® who spends the time training the entire team to teach the client relevant and functional skills that will make a difference in their lives. Be the BCBA® whose entire team can confidently say, Yes! This is making a great difference in the client’s life!

Are you interested in becoming a BCBA® with Attentive Behavior Care? Apply today!