Clinical Practice in Applied Behavior Analysis--Special Guest Jennifer Fitzpatrick, CPABA Conference

These days, there is no shortage of controversy over ABA treatment. The neurodivergent community, at least specific outspoken members within, often make general claims about ABA, calling it 'evil' and 'abusive.' Experienced and devoted practitioners beg to differ. Enter Jennifer Fitzpatrick and her efforts in organizing and successfully hosting the inaugural CPABA Conference for 2024. Her intent was to bring together professionals from both sides of the discussion to posit the role of ABA in medical treatment, specifically for autistic individuals. This was recorded prior to the conference, but publication held till now.

This is definitely an imperial oatmeal stout with robust notes of coffee and chocolate--a lot to take in and digest. Pour heavy, drink slowly, and always analyze responsibly.

Transcript

SPEAKER_02: 0:00

Welcome to ABA on Tap, where our goal is to find the best recipe to brew the smoothest, coldest, and best tasting ABA around. I'm Dan Lowry with Mike Rubio, and join us on our journey as we look back into the ingredients to form the best concoction of ABA on tap. In this podcast, we will talk about the history of the ABA brew, how much to consume to achieve the optimum buzz while not getting too drunk, and the recommended pairings to bring to the table. So without further ado, sit back, relax, and always analyze responsibly.

SPEAKER_04: 0:55

All right, all right. And welcome back to yet another installment of ABA on Tap. I am your co-host, Mike Rubio, along with Mr. Daniel Lowry. Mr. Dan, good to see you yet again, sir. How are you?

SPEAKER_02: 1:09

Doing great. Very, very excited. This is two guests in a row, so keeping up the momentum and really, really excited for today's guest.

SPEAKER_04: 1:15

I got to break into a little bit of an introduction here. We've been doing this for almost five years, Dan. And at the beginning, it was kind of like crickets out there. We weren't sure who was listening. And then all of a sudden, on our social media page, which didn't have a very far reach, I think we were just on Facebook, we started getting trolled. And it was like, wow, this is exciting. People are listening, and they care to argue with us. And then we realized they weren't even listening. They were just arguing with us.

SPEAKER_02: 1:43

And they saw ABA, and that was it.

SPEAKER_04: 1:45

And then most recently, which is super, super exciting, we've been getting a host of folks that have got a lot of good things to say. So we're excited to have Jennifer Fitzpatrick from the CPABA conference coming up here in October, I believe. Yeah, great. Jennifer, we're so excited that you found us. We're so excited to make a connection with you. I need to introduce you with a little bit more, which is to say we don't often pre-interview on ABA on Tap. We just kind of fly by the seat of our pants. But when we got your email, we said, wait a minute, we got to meet this person first and figure out a little bit more because you have a lot to say. You have a wealth of information for us today. We're going to do our best to keep up with you. I don't know how to say that here on ABA on Tap, but it's the truth. I think you've got a wealth of experience. You've got some very important things to talk about. We might even see controversial for some people, and that's okay. We're very glad to be able to host that. So without further ado, Jennifer Fitzpatrick, tell us a little bit about this conference and launch us off here today.

SPEAKER_00: 2:52

Well, thank you for having me. And yes, we are trying to get the word out about the conference. And you guys have been so helpful in that sense. The conference was established by a group of us. We just got together. I had gone to ABAI. I had gone to a couple other conferences. My daughter is graduating with her SLP and her BCBA license. I had been out of the field for a while. I thought I'm coming back into the field. And the changes just in the years that I had been out were astronomical to me. was shocked by what I saw. And I said, we really need to have a conference at one that's going to hit clinical work because we're still talking a lot in theory. And I'm not sure why our universities have not put programs in place. I'm not sure why our board hasn't established like a secondary certification that is required because we have sent these people out into the medical community with a lot of liability, a lot of, you know, there's lots of issues. I mean, there's lots of things that these young 24, 25 year olds are doing and don't understand the implications of, and we don't have enough senior, I think BCBAs out there to help

SPEAKER_01: 3:58

us.

SPEAKER_00: 4:00

They, it's just crazy. And so I, and then when I went to these conferences, I was seeing things being presented in isolation, which in themselves is not a problem. But if you have no other reference point to this, you have no other, um, there's nothing, there's no other way for you to understand this. You're isolated and you're one sided. You're, you're getting one view. So this is what CPABA is trying to correct. We're trying to put together, um, professionals in the field who have different views because guess what? Different views are good. It's what makes our system work if you have different views it pushes it challenges you so we're putting different views on the panels they're going to present the research they're going to present how it actually looks in practice because just because something works in say San Diego California does not mean that's going to work in Boise Idaho or going to work

SPEAKER_01: 4:48

in

SPEAKER_00: 4:49

Boston, Massachusetts. Sure. Yeah, and legally. I mean, it's not even just like it might not work. There's legal reasons. I mean, there are places in the country like in Oregon where they have very strict rules on restraints in schools and even in practices versus in Idaho where restraints are not an issue, so to speak. And so these are the real issues that people are dealing with. And so we have to start addressing them because what's happening is is that we don't have the training and experience in the field so people are altering practices or altering methods or we got i mean we have businesses that have business models that by all standards would not meet good practices but yet they're being They're going all over the place because why? Because nobody's pushing back. And the pushback should be coming from BCBAs, but we have such an untrained staff. And I know people hate when I say that because it makes, I'm somehow criticizing, but I'm not. I'm saying you can't think that you at five years old, or five years old, but five years of experience can be a clinical director. But yet we have three years and five-year-old people with that experience are clinical directors and running huge portions of things. They don't have the experience and the understanding and the legalities behind what they're doing. So we just have a free for all going on out there. And there's got to be a place where we can start controlling this. And this is what CPABA is about. It's not about coming in and presenting new research. I mean, you can if you want to, but it's more about how to get through. And then there's an underlying theme to CPABA that is also trying to bring in some standardization, which I know is a really bad word. Everyone hates that, too. But we need some standardization to try to help give some methods to ensure that, one, you can implement new research. Right now, when research comes out, I mean, unless your company or your group is embracing it, it's really hard to put it into practice.

SPEAKER_01: 6:42

Sure.

SPEAKER_00: 6:42

I mean, I could name five of them right off the top of my head right now. Break programs. Unless your organization does it, you can't put it in practice. There's got to be a vehicle for research to come into clinical practice. Standardization of documentation, standardization of training would give researchers some background. There's got to be a way to start connecting like what activities, what methodologies, what things work best with mediators. All of that has got to come into play or we're just going to be out here floating and we're going to continue getting more and more craziness in the field. So CPABA is trying to be... that place. We

SPEAKER_04: 7:21

appreciate that very much. I believe you mentioned that your daughter introduced you to ABA on tap. And if you listen back to some of our early episodes, we might be coming actually from the other direction and saying, hey, guys, a lot of what we've done in the past, at least for us in in-home treatment, for example, has been very authoritarian. We don't want to go that route. Somebody might hear you talk about restraint and fall right into that authoritarian piece and say, we're going to throw that baby out with the bathwater. Nobody does I'm going to pass it over to Dan here in a while because he's our resident expert on restraint. Well, not necessarily restraint, but something related. And you can give us your insight there, Dan. Now, I can go back to early in my career, the first time I worked in a clinical setting, a non-public school with sort of a wraparound psychiatric clinic on site. um i spent an entire year working there i did one restraint and it was almost i was almost coaxed into it i remember going through the setting telling myself they're they're using restraint as punishment here and uh it doesn't look good it doesn't feel good it happens way too often they think it's teaching something i don't think it is i'm pretty young professional at this point too just trying to figure this out So I was glad for that experience. I was glad for my mindset at that time. I know during our pre-interview, you mentioned the same thing. If somebody hears you talking about this, they might erroneously think that you're promoting restraint. You're not necessarily doing that. You're positing restraint. You're trying to find the right place. Mr. Dan, let me kick it over to you. Any insight on that?

SPEAKER_02: 8:55

No, no. I just really liked your input when we talked in the pre-interview that you mentioned. You said you've done it maybe a handful of times, I think you mentioned, Jennifer? Yeah. Is that right?

SPEAKER_04: 9:07

Over how many years? 20, 25 years, 30 years? Almost 30.

SPEAKER_02: 9:11

But I really liked the framing that you put into it in our pre-interview. When you mentioned, you know, we have the word restraint, and that will get a visceral reaction for some people. Yes, sir. But I think your premise, and please, you know, correct us if we're wrong, is that you were saying that there is a large subset, not large, at least a subset of population that we work with that does have pretty severe behaviors. And because people are ill-equipped to deal with the maximum level that that behavior could potentially get to, that people aren't just taking these potential clients or these individuals that need services potentially more than anyone else does. And because the demand is so much higher than the supply, it's easy for a lot of these outfits to just say, well, we're just going to take the individuals that don't escalate to this level. as a result of not having that potential tool in their toolbox. So I'll pass it back to you, because I wanna make sure that you explain it the way that you want to explain it, but I just thought that was a really cool explanation that you had, because when you first were like, ah, restraint needs to be more I wouldn't say you said needs to be more available, but it needs to be an option. I was like, huh? But then you kind of brought it back around of, oh, well, because these people aren't being able to be served because when they get to that level, the practitioners don't know what to do.

SPEAKER_00: 10:31

Yeah, no, I think what concerns me about restraints, and I will say this, is that. the untrained and not actually dealing with the issue is the most dangerous thing we can have in the industry because if you get up in a situation and you have to restrain and you have been consistently against it then you don't even know how to intellectually, in your mind, in a quick moment, figure out what's your next steps, what you're going to do, how do you get yourself in and out. It's dangerous. It's absolutely the most dangerous situation, and it's dangerous for everybody involved. So when I hear practitioners saying they're not going to be involved in it, I'm like, okay, well, first of all, one of the speakers who's going to speak was actually in a level five hospital, and she also works in a high-level situation with group homes with children, and they had really severe situations. and it wasn't just children with disabilities they had children with other juvenile situations and she's like you can't get workers to do this anyways because who wants to go in and get beat up every day but if you didn't have some form of restraint involved especially as a woman in a room with let's say a couple guys who are you know 15 and 16 years old who are you know 200 pounds you now have a danger situation and so she says we had to do restraints well That's the thing that worries me is that we have used like this overgeneralization. And by the way, I think a lot of things that are happening in ABA are overgeneralization. We have taken this thing and we just applied it across the board. And what I'm saying, the nuances are really the important thing

SPEAKER_01: 11:59

in

SPEAKER_00: 12:00

this. I don't want to suggest we all go out and say, and by the way, I have been very clear with, like I said to you guys before and with other people, I do not think anyone with less than a year experience in the field who has not worked full time and has not worked under a very well trained person should even be able or even have it in the repertoire because of the fact that it is something that could go really bad, really fast. But it does have to be dealt with and we do have to establish it. And I do think that if we force the board made it a requirement that everyone had to do a rotation in their clinical group work, that they had to go through a severe like a level five hospital or go through something of that nature, all of a sudden this conversation would change to finding practical solutions. Because there are places, like I said, there's a group in Australia right now that is not allowed to do restraints in the way we would consider restraints. And they have been highly, they're one of the biggest clinics in the world, actually, and the clinic in Australia. And their research is absolutely mind boggling and they have been able to do it. And that happened because of the fact that people who were experienced sat down and came up with a solution people of different viewpoints people coming from different backgrounds and that is what i feel that scares me the most about our field right now is that we're not seeing that anymore we're seeing people over here who aren't talking to people over here we're calling each other hitlers we're calling each other you know you're immoral and the problem is is that that is never going to get to a solution yep that is what we're trying to do at cpa ba we're not advocating to do restraints we're advocating that we talk about it and come up with the best solution possible for all people involved because it's not just a child involved there's you got parents and you got um bcbas you got bts it is a it's a huge issue that needs to be dealt with and i just think everybody's running from these issues because It's like they just don't want to deal with them because of the fact we just want to say what we want to say, have our opinion, and we want to go on our way, so to speak. And it's just not. It's almost like a cult. I hate to say that. We're all in these little cults in our homes. Sure. You know what

SPEAKER_02: 14:07

I'm saying? Yeah, I mean, that's why we started ABA on Tap, to be honest with you, is the discussion piece is we wanted to open it up because there's this huge anti-ABA movement and people that are very dissatisfied with the way the ABA service is being provided. And we're in the field and we're like, well, if this overtakes, then we have no field to work in anymore. So let's look at the legitimacy of it. And looking into it, it's like, okay, well... They make a lot of... And number one, who am I to tell anyone what their experience is? I'm saying kind of the movement as a whole versus anyone's individual experience. Makes a lot of legitimate points. That being stated... not all of them are legitimate. Again, they're legitimate to their specific situation, but maybe they're looking at the micro rather than the macro. The

SPEAKER_04: 14:54

over-generality that Jennifer's talking about.

SPEAKER_02: 14:57

Exactly. We just set out to say, can we create a discussion between people who do have a lot of experience in the field and people that are really upset with the field because right now this is what people are getting. This is the brew that people are getting, so how can we try to make this brew more... reaching to a wider audience so i think that's kind of what you're saying as well jennifer right of like that there's there's a lot of people on one end and a lot of people on the other end and like mike mentioned before we got on we got trolled in the beginning none of the people who trolled us listened to an episode you could tell because the things that they were trolling us about were things that we discussed in the way that they would have liked us to discuss in the episode but they just saw aba and they were like it's inhumane don't do it it's total crap They didn't even listen. They weren't trying to listen. And I think, Jennifer, that's what you're saying, right? With the conferences to just bring people together so that people can listen to both sides. Because at the end, you can probably find somewhere in the happy medium. But everybody on the other end just not wanting to listen can create some less than desirable outcomes. Am I reading you right on that, Jennifer?

SPEAKER_00: 15:59

Yeah, I think the other part about it, go even a step further, is that when you talk about this whole like ABA is abusive or ABA is this and that, right? okay let's just let's assume that it is let's just go with that theory right and let's just say i would want to take these same people and i want to bring them into a hospital and i want them to sit down and i want them to see what it's like to do have three-year-olds who are very sick two-year-olds who are very sick one reason why when you get into cancer units and when you get into some of these places like when you get into all-timer units i mean have you ever had to put a catheter on somebody who doesn't understand because they have alzheimer's what you're doing Okay, if you want to see stuff that is really just is going to cause you to have moral and mental anguish, let me take you into hospitals and work with sick patients and the reason why I say that is because we act as an ABA is such a public thing it's in the home it's intrusive it's you are right in that home with that family so everything you're doing is being observed and being part of it and then you have to translate that into the family network and make that ABA part of their daily lives so this is very intrusive it's very part of it so in that sense ABA is on display and I think that's why you see so much of ABA being attacked and you don't see these other parts of the medical community because it's in isolation. Okay, you would never have a family in a room while you're putting catheter in so they don't get to see that. But let me tell you, everyone in that room is experiencing it. And if they had the vitriol coming from the public calling them abusive I don't think we would find nurses and and we would not find staff who would be willing to do it and yet it has to be done because someone would die if it didn't get done kind of thing and I think that's why when you think about ABA we have to remember like when we talk about masking for example which is a big deal do you guys realize SLP spend probably 25 to 30 percent of their all their therapy is on masking. They just call it different word. I know that because I also have a background in language and my daughter's an SLP. And she was shocked when she saw all that. She's like, well, we do this, mom. Is this wrong? And I'm like, no, honey, it's not. I mean, masking, I understand the reasons behind masking, but I don't hear vitriol going after SLPs. And they teach it at a huge level. Why? Because it's not on display the way ABA is. And the thing you have to understand is that when you talk about human rights, I am absolutely into human rights. I was part of the group that said I was advocating before it became well known that women, for example, if you go into the hospital and you're in a teaching hospital, most likely you were going to have a breast exam done and you were going to have a pelvic exam done without your permission and without you knowing and for no apparent reason, because basically they cannot teach doctors in GYN unless it is. I knew about this 30 years ago and we were advocating And I was told to shut up and sit down, just like all the other women were, because how else were we going to teach these poor doctors how to do this? And I'm like, you can't get consent. So when we talk about consent, I always want to kind of go like, I can't believe I'm theoretically on the other side of this right now, because I was one of those early advocate to advocate for women's rights inside of health care, because we had so little. I was one of the first to be part of advocating for girls to be diagnosed differently, to have different treatment, because girls present differently and not to So I do have a very strong affinity for that type of understanding because I see it and I see how it's done. I mean, we have horrible outcomes in healthcare for minority populations. Even if they have the same education level, the same economic levels, they still have poor outcomes. So I'm on board with that. But I also want to tell people that they need to take a step back and put this in context. They need to take a step back and look at this in perspective.

SPEAKER_04: 19:46

Absolutely. You bring up the idea of masking, for example, is something that we were introduced to during one of our first attempts to bring on criticism of ABA to ABA on tap. It was Chloe Everett, I think, that first, at least for me, you know, gave me the first big intro to masking and how problematic it could be to the neurodivergent community from her perspective. You bring up a really good point, which is People get to see these more intrusive, more authoritarian methods that we do have to use many times for the protection of our own clients. They're right up front. And then I'm going to ask another question, and Mr. Dan, I know you've got some things to say. You don't have to answer this. We can contemplate this for later. But one of the questions we ask here on ABA on Tap is what can we do differently with regard to the application of something like masking that might make it more user-friendly? How do we modify the ergonomic of masking? And you probably have some insight into that as with your daughter. Mr. Dan, what did you have for

SPEAKER_02: 20:43

us? Do you want to go ahead on that one first, Jennifer? You

SPEAKER_00: 20:46

know, when people ask me about ABA in general, about what I would do and I wouldn't do, like social. So masking, I think, is really important. And people, I'm actually on the opposite of this because what keeps a community, what keeps us together is our social norms. That is what, I mean, that's what holds us together. And part of the reason why we are in trouble right now around the world with mental healthness is because our communities are breaking down. What we used to do, like the way we used to interact, where we used to interact, places in our communities are gone. We're losing them. We're now, the online presence is now changing how we interact. So we understand that if we do not bond and we are not integrated as a community, we have serious problems mental health-wise, and we're seeing it on full display right now. So social norms is what brings communities together. It's those social norms. So what I say is, do I want to, and by the way, again, I am a woman feminist who has been fighting for years, and I was in a very, very predominantly male-dominated situation, and I've lived overseas in some pretty male chauvinistic societies. So would I want to encourage social norms that would put me in a position that would be wrong? Absolutely not. I do not agree with that, and I would never tell a person to mask or social norms that would be detrimental. However, there are many social norms that are not detrimental. And we teach children that and we expect children and we expect adults to follow those norms. So, for example, I mean, I know everybody had to be flying and had to see the news and saw all these people acting crazy on planes. Not only was safety issue, but come on, you guys yelling at flight attendants and acting crazy on a plane. It broke all of our social norms. And we were like, people take a seat, relax, chill. There is no reason why you would not teach that across the board to every person in our society. If a child could not do something, if there was some reason that they cannot do it, That's a whole different story. And then I say, let's figure out levels of ways around it to make them more adaptable into society.

SPEAKER_04: 22:52

Sure. So

SPEAKER_00: 22:54

go ahead.

SPEAKER_04: 22:56

Maybe those issues all over a different type of masking. But I digress. Maybe too soon. Mr. Dan, go ahead.

SPEAKER_02: 23:03

So I guess a question that I would have for you regarding that is. Yeah, totally. I think it would be ridiculous for people to say that they. there doesn't have to be some level of masking, right? Like I have to wear clothes when I go out, right? I could say that I want to express myself, but there has to be some level of masking with social norms and also within the rights. My rights can't infringe on your rights. My question would be, would that, so I think one of the alternative arguments that could be made is that, yeah, masking makes sense maybe in certain social circles and it's also relevant to those certain social circles because like maybe dressing up like a furry might not be acceptable like at work or something. But if I'm with my furry group, then I can dress up hypothetically like a furry. All of a sudden, I'm a furry. But nonetheless, potentially not within somebody's home, right? So is that potentially one of the arguments that's made of, yeah, I can choose when I want to go out, and then I can choose knowing that I'm going to have to mask in this situation. But if I'm being forced to mask in my own home and behave and express myself in a way that I don't resonate with in my own home, is that different than what you were saying, Jennifer?

SPEAKER_00: 24:11

I think the big thing that you use, which has been always my big thing, is because, again, I'm going to use, because I grew up in a different situation, I knew the rules and I could choose to not follow the rules or to follow the rules.

SPEAKER_01: 24:29

Sure.

SPEAKER_00: 24:29

Often what I see with children in autism is that they don't know those rules. if you've ever been in a classroom with kids who come from say a lower economic social situation and they're put into say a room with a whole bunch of high functioning um a higher income and they're getting rejected because there's um problems with behaviors it is it sounds horrible right everyone gets upset when they when i say that but i said if you actually teach in a first grade classroom, you see it and it breaks your heart because the child who's over here doesn't understand why they're being rejected. They don't understand even how to be nice, giving them their food, giving them giving their toys doesn't get them a door through to that group. It's the behaviors that that group recognizes. It's almost like it's all like water seeks its own level kind of thing. They go to where it's comfortable. So here's what I have a problem with when people say, I don't want to mask and you shouldn't be allowed to teach masking. If I'm teaching someone who has the ability to make that choice, then I'm giving them freedom. I'm saying you can either do it or not do it. but the problem is is that many people don't even know what it is that that they need to do in order to enter into whatever they're doing they have no choice because they you can't choose something that you have no options to and that's where i'm saying like if someone said to me i don't care like i i'll be honest with you i work in most of our profession we do have some people who are on the spectrum i've had friends that i've worked with who were just like are not friendly at all they choose that I'm good with it. We're all good with it. It's our choices. But if they wanted to have friends but didn't understand why or how, that is a real problem. Because once again, I'm going to come back to this whole social network thing. We are humans. Humans like living, like we'll call them packs. We like to be together. And the fact that we're so disconnected already and our society is so unwilling to accept each other the way we are, If you add to that these other antisocial behaviors, which, again, if you want to call them whatever you want to say it, it causes division. It causes it separates these people. And I'm saying if they want to be separate, that's one thing. But at least give them the skills and the opportunity to choose. That's all I'm asking people to give. Open up the door. Don't call masking a bad thing. Just

SPEAKER_01: 26:54

share.

SPEAKER_00: 26:55

allow people to choose if they can choose and they can choose which way they want to go

SPEAKER_04: 26:59

yeah yeah the general idea here being that in a general sense the idea of etiquette or being cordial I mean that's constant masking for most of us and most circumstances, to be fair, right? I mean, no. You just mentioned being at work and somebody doesn't want to be nice, somebody chooses to be nice, you still have to subscribe to a certain code of conduct. Otherwise, one of you is going to be, you know, outed or not going to be around anymore. So, I mean, that's in general masking. And then, again, the question of how authoritarian is the application of that masking in terms of the person's choice. So, on one end, we might not give somebody a choice but to mask. On the other end, I think you're the risk of assuming that somebody isn't capable of masking and then we don't teach it at all and we leave them devoid of Yeah, no, thank you

SPEAKER_02: 27:54

for explaining that. I think you did a really nice job because, like you're saying, masking kind of has this negative connotation, right? And there's a place for it and there's a place not for it. And on either end of the spectrum, it can be abusive on either end, just like manipulation or... consequence right people hear the word consequence they automatically think it's going to be something negative or manipulation they think it's something bad but we manipulate anybody we do a first thing contingency right

SPEAKER_04: 28:18

so reinforcement consequence all mean punishment

SPEAKER_02: 28:22

correct absolutely at

SPEAKER_04: 28:23

least in the public eye

SPEAKER_02: 28:24

so I think what you're saying is the word masking like any of the terms like there's there potentially is a time to teach it and if we do it with care and compassion there's it's not necessarily a bad thing but we noticed that too with some of the trolls that would come up Initially, they would hear a certain word and we would be down a rabbit hole. And it's like y'all don't even want the nuance or hear the nuance. You just hear the word. So thank you for explaining it. I want to make sure that we give you adequate time to explain all of your your things that you're bringing forth. I want to go back. You brought up a pretty salient example about the it wasn't the chemo ward. It was the catheter in the in the hospital. So obviously in hospital, in any medical procedure, it's always risk versus reward, right? So I want to ask you and have you elaborate on. So in your example, you said, you know, yeah, in these situations, it could be death, which is the alternative. And I think Mike is a dad or most parents, when death is the alternative, they're willing to take a willing to risk a huge meltdown and a lot from their kids. And one thing that you brought up was that one of the reasons there's not the vitriol behind that is because it's behind closed doors. The other could be because basically the alternative is death. People are willing to risk a lot more. With autism, the alternative isn't death. So what is your thought about that? Was my question clear or should I articulate

SPEAKER_00: 29:51

it better? No, no. I agree with you on the sense that, I understand your question, but I disagree with your premise. Okay, please. I think death would be easier in a lot of these situations. I think if you've ever worked in a school and you've ever seen kids isolated, see, what's worse today than it was 30 years ago when I was in school or 40 years ago was we used to get bullied, right? But you know what? When you're being bullied, that's bad, but they see you. Today, they just ignore you. go talk go into schools they don't bully you they just ignore you so if you don't fit the norm of what's going on in school you don't exist anymore and I want you to think about that we as society have created a population of people who just don't exist so I disagree completely and I think it's also a sign of how we just don't really understand mental health and we don't understand what's going on in our world being isolated is not being ignored not being seen i mean i'm over 50 now and um i i remember reading about how women when we change how we become less significant in populations and i'm experiencing that my daughter is blonde blue-eyed beautiful and she walks in and they attend i mean they run up and attend to her when we go into stores i walk in today i can walk the whole store and no one even tends to me i'm becoming unnoticeable and other women my age people tell you that and as we get older it gets worse sure so what i'm saying to you is that is that when you talk about these things that anything that is isolating a child from their world out there i think that should be taken with the same grain of salt as if they're going to die because that isolation is going to lead to serious mental health issues long term and it's going to just fragment our society more we need strong families we need strong communities we need strong our schools are in breakdown right now everything is breaking down because we don't have those things and the more we are connected the more we are structured and we have the the those interconnections working the better we support each other and the better we do as society and we have less fights as society we have less arguments we are allowed we we allow diversity Do you realize that the very argument that about diversity and about those things come into play when everybody in that society is interconnected and their needs are being met? When we see people attacking other people and going after other people, it's because if you actually talk to that person, their needs are not being met and they're angry because we are trying to place somebody else's needs above theirs. So when you listen to people talk, you will hear that over and over again. Like today, like when you listen to politics, why do you have these groups fighting against each other? It's because the person's needs are not being met. And so, no, I think that we have to figure out a way to help bring people together. And that means we have to be using our social skills training. I mean, I think neurotypical kids need social skills training. So I'm not just advocating for just special ed kids, okay? But we need to teach them. And the kids who need more support, we shouldn't be denying it to them. We should be giving it to them. And whether they choose... In the long run, how they do it, I mean, every child should have a choice over their clothing and over how they act and how they interact, what groups are part of all of that. I agree with. But I would also probably be on the extreme side, and I'm probably going to upset a lot of people. but I'm going to say I think kids have to join groups like I don't care if you join the band I don't care if you join basketball I don't care if you join chess I don't care what you do but if I were a parent I would force my kids to join groups in the high schools and in the and then middle schools and then um and find art school I don't care pick a group art school do something because we have to help these kids get integrated into society, whatever that is. So, yeah, so I'm on the other side of it. I think mental health is our number one problem in this country right now. It's

SPEAKER_04: 33:58

an interesting philosophical paradox that you're presenting. And I think that we've talked about this or we alluded to this in our, you know, in our previous episodes. The idea that You can isolate a person in this circumstance or in this example, at least in a couple of ways. One way is to make their treatment so specialized that they are so different from other people. And then you're talking about the other extreme, which is sometimes people saying, no, just laissez-faire, let this be. And then you're not getting the particular individualized treatment that you're supposed to giving your basic needs. So it's an interesting paradox. I don't know if either of you guys want to comment on that. Anything? Yeah,

SPEAKER_00: 34:40

I think that moderation, I mean, we cannot live in moderation in this country right now, and I don't know why. Either you are so one way or so this way. And I guess I live in moderation because, like I said, I live in two states that are literally the most conservative state in the country, and then I go to one of the most liberal states in the country. And I think people are people. Yeah. moderation is the place if you are forcing your kid to go do your relive your high school years that's wrong we all know that right we got that but i don't think it's wrong to force your child to integrate within the school system that they're in because they need that whatever that interest is i don't care just they have to find an interest right

SPEAKER_01: 35:22

sure

SPEAKER_00: 35:22

um so same thing with everything if everything you do you approach it with just a moderate level head balance approach um sometimes you're pushing sometimes you're pulling back it's you know i call it I hate to say this, but ABA is good parenting. You know what I'm trying to say? It's just good parenting. You're kind of pulling. And so sometimes you have to mask. Other times you need to live and be in your own truth. You need to be who you are and people need to accept it. So it's that push back and forth. And as long as you're doing it in a moderation and you're doing it, you know, and you're giving your child the most options, the most freedoms and the most choices, and they're authentically choosing what they're doing, I think you can't go wrong And I think the same thing in ABA therapy. I mean, once I give a child the skills, if they choose to use the skills, great. If they choose not to, that's okay too. But at least they now have the ability to choose who they want and what path they want to go. Without those skills, they can't choose that.

SPEAKER_04: 36:19

That makes sense. Now, you've mentioned training several times, which I think fits right into here in the sense that maybe given the need and the quick proliferation of ABA and help therapies to address challenges for autistic individuals, for example, therein, we run the risk of not diversifying our treatment, of teaching this very linear, at risk of being too authoritarian, just do what I do because You're the one that's affected, and I'm the one that knows how to fix you. So I can see where we can get into trouble here. And I think you're talking about that. So let's talk about training for a little bit and what else needs to happen here, knowing that you've got a conference coming up that wants to discuss all these things. In your terms, having come back into the field, knowing that we're in the middle of it right now, and yes, we do see a lot of problems, where does the training fall short? What are some of the possible solutions?

SPEAKER_00: 37:15

So I think one thing that a lot of young people are not aware of and have not understood about the background of not just ABA, but hospitals, medical, academics. And this is the part that I think the young people really don't understand. Up until the last maybe 15 or 20 years, women did not have a voice in any of this. And the reason why that's an important thing to understand is, and I'm not trying to be sexist here, but men generally are authoritative. So I want you to think about how academics were taught. If you think about in the 30s, 40s, 50s, 60s and go through, it was very teacher standing in front of the room, everyone would be quiet and everything was done. ABA came out of an authoritative type of environment, but that was applied across the board to all environments. One of the benefits of having women in a field is that we bring a different perspective. I have never felt authoritative at all with ABA, which is why when I hear the ABA, I'm like, I don't understand where this is coming from because it doesn't resonate with me, which is also why I think women are more open to that side. And I think even young men now, but I don't think they get the fact that I remember being in school and I remember doing clinicals. And I told this when I was in my early twenties, I was doing a clinical and I remember the doctor was older, very well established. And he just said, he literally turned around and looked at all five of us and said, do not speak. do not talk to me. If you bother me, I will kick you out and you can start over in another place. I literally have you tracking along. There's nothing you're going to say. There's no question you're going to ask that's going to be worthy of my time. You are nowhere near where I'm at. Just follow and get your credit. And that is how he talked. And nobody, there was no going to principals or going to administration. My high school teacher explained, who I absolutely love, by the way, and wrote me one of the best recommendations. wrote me explaining in class to us why chemically women were not able to have as clear thoughts as men because we had different hormones when i tell that to people they think i'm crazy right okay mr martin was he was the most loving man you will ever meet he actually does not believe in the route i took with my life he thought i should have done a different route but he wrote me a great letter to go to college So I try to explain to people that this authoritative thing doesn't exist anywhere in our world anymore. There is, I mean, there's no authoritative abilities in schools. I mean, you go into the schools, it's a free-for-all now. I mean, actually, I think some people would say we kind of need a little bit more authority, okay? You go into healthcare. I mean, you have patients coming in telling doctors after, you know, doctors have 20 years experience using Google to try to explain to the doctor what their problems are. And the doctor's going like, okay, I mean, we have broken down on all that authoritative lines. I mean, look at politics. I mean, that all has gone out with, it's all gone. I mean, we are now kind of in a new world. I don't think ABA could ever be authoritative because I don't even think families today, the way they parent, the way we operate, would ever allow that to happen again. And I'm saying it should happen, by the way. I grew up in it. I can tell you it was not a great model.

SPEAKER_02: 40:31

Yeah, I might push back a little bit on that, though. I think kind of the idea of refrigerator parenting and blanket extinction and things like that did come from. maybe misapplied ABA. So not ABA in general. And maybe that's what you're trying to say, that training piece, which is so important. Because I think a lot of what you're saying is we just need people that know how to do it better. And it goes back to your original point of people coming out of these graduate programs thinking they know everything with no experience and then misapplying it. But then at the end of the day, ABA, I mean, that's the whole point of the BACB, right, is to regulate the practice of ABA. And it's only going to be as reputable as the people that are practicing in ABA. Mike and I, I mean, I remember one of the people left our company um we went through a little bit of a renaissance at one of our previous companies um and when we told this person hey you don't necessarily have to take data on every single trial that occurs because you can still get an idea and i felt this person's head was going to explode and they literally left the company reported us to the board and which went nowhere on like if there's one trial that occurs and there's no data that's taken his mind would explode um so i think a lot of what you're saying with with relevant training uh makes sense but But I would push back that the way that, not necessarily the way that it should be, the way that it has been done because of the lack of training and the lack of oversight has led to, and we typically use authoritarian to communicate what you're saying, authoritative, just so if any of our listeners come, I think what she's talking about is the authoritarian side of things. I think it has been kind of authoritarian and how it's been promoted as, if you don't give me the exact behavior that I'm looking for, I'm going to withhold your entire environmental stimuli and you're not going to get access to whatever you want.

SPEAKER_04: 42:19

So it's sort of striking the balance between a uniformity in terms of an environment and then those exceptions to the rule which maybe are managed in a way that then the uniformity is able to absorb or maintain. The idea that there's not this back and forth shift on the seesaw that's way too long. It's okay to have opposing views. but the idea that the further apart they are, the more polarized things are, the scarier the seesaw ride is, I guess. And thank you for making that clarification there, Dan, just because I think that you were making a great point. We often talk about Diana Bomren's parenting styles here, so authoritarian being sort of the one that you don't want to spend too much time on unless your kid's running out in the middle of the street and no isn't enough, and then the authoritative part being the more collaborative piece. And I think you make a really good point, again, with the idea of your experience and how a very strict structure, although it wasn't an ideal situation, and you're glad we've progressed away from that, however, it did ensure that you learned what you needed to learn. And if we don't have some semblance of that, then to your point, it all starts falling apart.

SPEAKER_00: 43:28

Yeah, I do. And I agree with you. I would actually love to have some VC or some AVA people come out who are actually doing what you said, like they flip out because of the fact that you didn't take all the data because you can fix that. I agree with you. That you can fix. Have you seen some of the new stuff that's going on out there? Like they don't take any data. Like, they don't do any data. And the thing about it is, it's really interesting that what I've seen with the training part that really scares me is, and you talk about how they think they know, a lot of these young people know things. It's like, I can usually walk in, because I've been in and out of programs, and I was trained a little bit. I was trained out of some areas, like in D.C., where there was lots of different views. And if I wanted to work, I had to be able to move among all these different views. I can walk in and generally look at what someone's doing and give me a couple minutes I can figure out philosophically what they're talking about or what they're going back for right I could go into these rooms and I was consulting I can't do any more driving nuts but I go in and I'll watch I'm going what are they doing like what is going on in here and then they say oh we're doing play therapy and I'm like play therapy this is not play therapy I don't know what this was but okay and then I find out the person has you know the the BCBA has read a book And so they now know, or they're doing RFT because they did Foxy, was it Foxy Learning? That made them an expert in RFT now. So now they can do RFT. And I'm like, wow, like that is a problem. And I think we talked about that, about the authoritative behaviors that we do and how it's all one mindset. there's a slight part of me that was like, man, I would really love to have that back and play a little bit because I can actually move those people into a more moderate response format. Kind of like what you guys do. Like you don't have to take data on every single stool. You don't have to do it exactly this way. You can moderate it to the child and you can change things and you can move things around. I would rather have a starting point where everybody was trained very rigidly and then move them that direction, where today I feel like everybody is being trained, it's like a free-for-all out there, and they think they know what they know, but they don't, and trying to bring them back to a more established method so that you can kind of move them from that point forward, I think has been really difficult. I was shocked that most people could not tell me where, like I said, in the A, B, C, where would you create a new behavior? I mean, I can't tell you how many of the BCBAs would say to me, oh, well, we're just going to reinforce. And I'm like, reinforcement assumes you have a behavior. For sure. Or at least some behavior, right? What method? I said, pull up your Cooper book. And I actually had a person say to me, oh, yeah, we didn't use that Cooper book. And I'm like, we're just going to try today. Pull it out, but let's look at it. Where do you create a behavior? Where in your plan do you even have a skill or a method of how you're going to create this behavior that is absolutely mind-boggling that you can get through school and now work independently, creating plans, and you are now a clinical director at a major company over multiple BCBAs, and you did not know the basic five ways to create a behavior.

SPEAKER_04: 46:40

Sure. The need is at fault for that, I would say, right? A lot of us moving very quickly, and I say us just to be inclusive. I'm entering my 28th year of practice, so I'm going to say I've paid my dues. Mr. Dan, you had something for us.

SPEAKER_02: 46:53

Yeah. I did. Oh, yeah. I think you bring up a good point. And we've actually done episodes on this about collaborative therapy and about BCBAs kind of staying in their lane. I mean, we are the experts of behavior, and that's where data comes in. We're not the experts in play therapy. We're not the experts in speech. We're not the experts in occupational therapy. We're not experts in recreational. So the more we could be almost not utilized to even suggest any therapy per se, but to work with the play therapist or the recreational therapist and just... Take data on what the behaviors are occurring and say, okay, well, this is what the antecedents, behaviors, and consequences that we're noticing when you're doing it. So this is what you can do to increase or decrease the behavior rather than suggest any particular therapy. I think you do bring up a really interesting point there. I will say with the data point. And one thing that I see a lot from the field and I've heard from I've seen it and I've heard from a lot of people who've reached out to us specifically recently is that in theory, data, data does make a lot of sense. But what we're actually seeing in practicality is that these parents are saying they see their supervisor maybe once every month. And I mean, this is all violation of the ethics codes, but maybe I'm saying what's actually happening out there in the field. And if you're asking an RBT to take data on a five day a week session and the supervisor is viewing it Maybe once a month. That data is not being used anything usefully by the time that the data is showing a trend. You're talking about three more weeks before somebody comes out there and even does anything with it. So I think in the lab or how it should be done, sure, then data, if you're taking regular data, then those modifications can be done immediately. But if the supervisor is not being out there, which again, we're hearing is unfortunately, it seems like more of the norm than the exception to the rule, then that data is kind of going nowhere and it's just becoming frivolous.

SPEAKER_04: 48:47

Data becomes a matter of documentation, a matter of meeting the regulations. And I mean, I tend to see my... clients and my families and my RBTs a lot. And then when I do take a peek at the data, it makes sense because I've seen what's happening in vivo as opposed to taking a once-a-month snapshot, if it's even once a month, of a bunch of data points that may or may not have been collected effectively, may or may not be tied to true SDs or good incidentals or might not be a good sample of the data. It could be the RBT just wants to get their session done, so they're just here, oh, they did it this many times and this many. times we're a minus and yep so on not to mention other things that we've gotten into like you know percentage of opportunity why are we the only ones presenting opportunities doesn't the rest of the environment present us these we believe it does or what does that data mean you know

SPEAKER_02: 49:38

or with that with what you're saying like if i've asked this kid 15 times to say their name but i haven't gotten their attention one time but i'm saying this kid doesn't know how to say their name that's again that's data points but data on bad programming is bad data

SPEAKER_04: 49:50

and then the child tantrums and now they're tantruming for who knows what function well maybe because they satiated on you asking them to say their name. I don't know. I might've stopped responding. Dan, if you sit here and say my name 15 times by the fifth, I'm probably going to start ignoring you. I don't know. Just a thought.

SPEAKER_00: 50:07

I agree with you on that context, but I'm going to try to persuade you in a whole different direction. And I'm hoping you keep your minds open and I hope you guys become big

SPEAKER_01: 50:17

advocates.

SPEAKER_00: 50:18

Keep your feet big out. We need more data to, and more documentation and not less. And I'm gonna tell you why, okay? Just gonna throw this one to you. I was trained in the hospital, so I do data through the hospital. So we do every 15 minutes. And I trained in my company, I did that. And because I required that type of, meticulous work my bcbas only had five clients and they were on site with the um bts um for a whole day so like if we had a 40-hour thing they had they did their 40 hours they were there all day on monday for example and they were doing and because of the way i set up my notes and everything they were demonstrating they were so what i'm seeing is scaring me is that Because we all know, because we're all experienced, the three of us, we get it. If you're going in and doing 5% supervision on a case and you're there once a month, who cares what the data says? Because by the time you get there four weeks ago, that data doesn't even make sense. Who cares? It's a waste of time. Let's not do it. But here's the problem. We are changing the methodology to fit the problem, not the... fixing the problem. And here's what really scares me, because I'm going to tell you something that I came across, because one of my old students called me and said, Jen, what do I do? And then I called Eric over at CASP. And when I realized there was no real good options, I was like, we are in serious trouble in this situation right now in ABA. I mean, I thought we were in trouble, but now I really think we're in trouble. There's a company out there that's in multiple states right now that's operating. It's very big. And there's many, not a few, many BCBAs on staff working. And this company does not have any cases assigned to any BCBAs. So basically, you give your hours that you are available to work. And then they give you cases that are available during those time periods. So no

SPEAKER_02: 52:16

continuity.

SPEAKER_00: 52:18

None.

SPEAKER_02: 52:19

Okay.

SPEAKER_00: 52:19

And only one BCBA... who is on staff, who does none of the supervision, will alter the goals

SPEAKER_02: 52:28

by themselves. Yeah, we see that, unfortunately.

SPEAKER_01: 52:31

That

SPEAKER_00: 52:31

is

SPEAKER_01: 52:31

crazy. That's crazy.

SPEAKER_02: 52:34

Yeah, we see that with some of the hours rat races and things like that about trying to hit billable standards so you're going out on whoever's cases that you have no idea about just to hit hours. I will say with the way that insurance or the way the aba is administered um does create an issue with data taking because you're having the same person administer the program and take the data which can be challenging because anytime you're taking data you're not engaging with the person so potentially in a medical setting maybe you do something and then you go and you're away from that person for a minute and you can take your data you're not necessarily there the whole time so I think it can be very challenging the way that the current ABA therapy is administered. Now, if you have a supervisor taking data on an RBT, that's great. Or if you're watching the session afterwards and you can take data in vivo. But what we find that in vivo happens a lot if you're asking the same person to take data and engage the kid is it gets really herky-jerky and then you lose all of the momentum. And then the actual thing you're trying to take data on suffers because you're just trying to get data.

SPEAKER_00: 53:41

I'm going to push back just a little bit on this one. I'm going to try to say look at it from a different perspective because this is how I trained my staff and I trained my DCVs and everything to do is that you notice how like we went from being very unstructured when we were parented kids and then we went to like now kids are like are literally booked from morning to night and it's very structured. So one of the things about ABA that if you do highly structured something highly structured and then you go to you need to give them unstructured time. Kids need to play. They need to have they need to have moments of unstructured time and they need to develop independence and all stuff. So one of the things that I think data collection does, it's a built-in system. It forces the BT and the BCBA to plan in their sessions, okay, I'm going to do these three things with the child. Now, the child's going to have to be alone for about, you know, five, 10, 15 minutes, whatever it is, so that I can put this stuff together, get the next system set up. I can take data. What can I do? that effectively has this child engaged allows them to do it and and not become I can't have him running around the house crazy making craziness how do I do it it forces them to help the child learn how to be independent because one of the things that most of the parents that I worked with who had young children would say was the biggest change in the first six weeks of their of their lives is that our family functions better is because for the first time their child now is able to engage in independent activities that are engaging even at four three four and five years old it forces the to deal with that particular issue. It forces them to deal with self-regulation because if the three-year-old just starts screaming, yelling, and going crazy in the house or goes and starts knocking on windows, there's no self-regulation. So I would say that having that built-in forces, one, it gives you good information. It gives BT time to reset so that they're not overloaded. They're not just going boom, boom, boom, boom. It gives them a chance to read the programming. It gives them a chance to kind of get themselves in play so that they give really effective treatment. It allows them to take the session notes and make comments and say, hey, you know what, we really had a rough morning. I think this activity is causing some issues, a way to communicate with their BCBA. And it gives and it forces everyone involved to help that child learn to self-regulate, to self-entertain and self-motivate themselves in an independent activity. So I think data collection is essential. And one of the reasons why I wrote my books, you know, my textbooks are all about data collection because I think that it's like one of those missing pieces of the pie that we have moved because of funder issues because of poor training from the BCBAs and from the schools and because we see it as a way to meet the big brother You know what I'm trying to say? We've missed what really, and like I said, I was trained in hospitals and I see how hospitals use data. And that's probably why I see data that way. But that's my only pushback on that one. I think data can be a good thing.

SPEAKER_04: 56:41

So we don't disagree. We like the data. I think that we're coming from the angle of that was posited first. So the idea was, I like to use the example of an ABA, at least in the old days, we often planted a seed and watered, and we'd sit there measuring. And there was no sprout. What the hell are we measuring? But now I say, hey, once you see a sprout, go teach, go teach, go teach. You see a sprout, go measure the sprout. And so I think we agree on the data part. We're coming from the angle of data was way too intensive. And initially we were trying to recreate the whole session with every singular data point, which I like to say, if you're texting, who's driving? If you're taking data, who's intervening? Nobody, you're taking data. So I think that's what Dan was referring to with herky-jerky, the idea that you're going back and forth, back and forth, versus the notion of momentary time sampling, right? Something like that. So we agree on the data. The data is important. This is kind of like what your conference is gonna do. We're coming from two different sides of it, but we compromise in the middle. Data is important. Mr. Dan,

SPEAKER_02: 57:45

take this away. I was just gonna say, I totally agree with what you're saying, and independent leisure skills are very, very important. I think one thing that you run into, though, with the way that maybe you're talking about or the older school way that ABA was administered is the person is there administering the structured time, and then unstructured time basically independent time so therefore the rbt now becomes a condition adversive because the only time that they're there is they're running the structured program and breaks mean you're away from me so i'm not really there during the fun time so i think we try to integrate the structured time is more like within the routines that they're having because a lot of the kids we work with get plenty of structured time at school so for us to come into your home and say not only a structured time at school but now home is structured time can be challenging to then take data in congruence with how we're administering the program.

SPEAKER_00: 58:36

No, I agree with that. And I think that that makes sense. But I will say this. I'll go back one step. Sure. Is if you do 45 minutes of structured time, structured time should be incorporating that play and social skills. Sure. So you should be doing that. When I talk about structured time, it's like I'm incorporating anything that you're doing where you're actually putting an intervention in place that you're actually incorporating you're directly involved in whereas I do think kids because I mean I'll be honest with you if I'm with adults all day and I have to sit and talk to someone for you know hours on end I need to go get a coffee like I go I go to the bathroom that's my way of escaping and finding a way to have 10 minutes down or 15 minutes down and I do think that in an hour time frame giving a kid 15 minutes to have downtime and do something that's self-regulating self-structured is it was good in my opinion in that sense but I do agree with you if you're doing very structured activities like DDT for 45 minutes and then you give them 15 minute break without question, the adversity is going to come. They're going to say, oh, the BT is an adversive type of a situation. But I would venture to guess that they should do 15 minutes of DDT, probably 15 minutes of social play and interactioning, and then 15 minutes of some type of communicative interaction, maybe with the family members, interaction within the home so that the family is being, their needs are being met also. And then 15 minutes for the kid to kind of like ignore you.

SPEAKER_04: 59:58

That's the negative reinforcement. reinforcement time, right? That's my girlfriend's favorite 15 minutes of the day. Negative reinforcement, get off my back, basically. I like the way you put it. I think we're talking, again, I think we're talking about the same thing from two different sides. One thing I love talking about, just given my developmental background, is the idea of child-directed, especially for early intervention, the idea of child-directed intervention, right? So when I tell people about that, they're like, oh, so you just let them do whatever they want? I'm like, not exactly. Well, we need to have structure. And usually when people say structure, what they mean is adult-directed It means I've picked the materials, I've picked the time, I've picked how long we're going to do it, and it doesn't matter what you say because the moment you cry about it, now you're protesting as opposed to communicating, hey, man, you're not giving me enough of a chance to do this myself. So... I think you're absolutely right. I appreciate what you're saying in terms of that balance and that dance from, hey, I've got the structure. I've got a plan. I think I know what materials we can use to teach you toward the achievement of these goals. And then all of a sudden the incidentals occur and kids do what they do, which is derail you. And now the experience and your training now prepares you to turn anything that they're interested in just about within reason Now back to your goals. And I think that's the hardest thing that I, at least in my career, the biggest challenge I've faced is trying to explain that to people and saying, hey, I'm not saying don't plan, even though I can sort of tell that after 28 years, I can kind of walk in unprepared knowing that kids have toys. We know what we're talking about. Again, I feel comfortable, but it's taken me a long time to do so. And I'm trained in that discipline. I come from a child directed developmental early childhood best practices kind of background too. So it's been a great analog to my ABA and hence my position right now. I'm kind of, okay, ABA might be a too authoritarian. Well, that's not fair to ABA. I think I'm talking about the way certain practitioners implement it. Now, this has been a perfect balance here. I think this really harkens to what you're trying to do with your conference. Dan, did you have anything for us before I... We're at the hour mark, so we don't have to rush off. We're having a great conversation, but we do like to keep it in nice, digestible chunks of about 60 minutes. Again, Jennifer, I have no doubt that whether before October or after October, you're going to be back on the ABA on tap, so we're very glad to have you here today. Mr. Dan, did you have something for us today?

SPEAKER_02: 1:02:16

I did. I had one more question, and I also wanted to open it up to you afterwards to speak about your conference and mention anything that you wanted. So what we were talking about earlier, we kind of went down on some tangents about kind of the, and I agree with you about when you were talking about social interaction and the importance and things like that and even some of the comparisons that were made there were pretty significant. What are your thoughts on ABA kind of like the end justifies the means or even affirming the consequence, saying that because whether it's social interaction or whatever it is We were talking about the catheter example. Because it's so important, then people kind of have carte blanche to do whatever they want to get it there because of the importance that we put on it. What are your thoughts on affirming the consequent with ABA? That's my last question, and thank you. I'm interested to get your perspective on it.

SPEAKER_00: 1:03:08

I'm probably going to fall again in the same way. I'm probably going to trigger some people. So I'm going to try to be, but I am very much an environmentalist and I am completely freaked out that if by 2030 we don't cut commissions by half, we're going to be in serious trouble. So I'm at the point where I'm like, the ends will justify the means here at this point. Whatever we have to do, we have to do this, right? That's kind of where I'm at. And that means a lot of people are going to get hurt in order to make the change that we have to make from point A to point B in order to save our environment and save our planet, right? So when I say that about, about practitioners in the field, there's also a secondary level here that I realize and I have been brought to my attention on this level because I have worked with some younger people who are now doing stuff with me who have had years in experience and one of them was Elizabeth and she said to me, Jen, you have a very close, very tight knit group of people that you have been around that you don't see what's really happening out there. So it says you have this faith in people. You have this belief that people are always going to err on the right side you just do because and you have and they all have competence so you know they're not going to make these bad decisions so this is all hypothetical to you but I actually work in the field and I see where people are making some really bad decisions and we're seeing some really bad things and she's like I worked with you Jen she goes all the things that you do with Ascent and all those things that they're out there compassionate care trauma informed she goes you do it all the day in all of your ways you do it naturally you don't even realize what you're doing she goes you do it better than the people who have levels by certification, you know? And she said, so she says, you just don't understand what's happening. And so that is what scares me. And that's why for the first time in my life, I'm going to show some hesitation here because if you ask me, absolutely ends justify the means because there's never going to be a time where I'm going to do something that is going to cross that line. That's going to be a problem where the ends would not justify the means.

SPEAKER_01: 1:05:10

Gotcha.

SPEAKER_00: 1:05:11

I do not know with the level of training and what is happening. And after finding out what is going on with like BCBA is thinking it's okay to not have cases and that they just pop on to get their hours in to get paid. That's okay with them. That does bother me. That makes me nervous and makes me say we have a problem. So yes, at this point in the game, no. Be very clear that I would not put my, I never hired someone and never had anyone work for my company that I would not be willing to put my daughter with. And I can tell you right now, 75% of ABA out there, there'd be no way I would put my child with them. So that's what I think about ABA at this point in some ways, okay? So I understand parents. I absolutely understand where parents are right now. If I were a parent, I'd be scared. That's partially why at the conference, we've all opened this up to parents and we want parents to hear all the conversations because that will help them have a better judgment of what they're seeing in front of them. Because I will say, I do think 75%, and some people say that's high. I don't think it's high. 75% ABA therapy out there right now would not be therapy that I would put my own child in.

SPEAKER_02: 1:06:20

Gotcha. So what you're saying, just to make sure that I understand, is that it does, but with proper training. And the current ABA is lacking a lot of proper training. Is that- Am I understanding

SPEAKER_00: 1:06:29

that correctly? Okay. You're a skilled expert. I think you can have a lot of leeway because you're going to balance those pros and cons very well and you understand them. I think probably 70, 80% of the BCBAs out there do not have the experience to be making those kinds of decisions. And if I were a parent, I wouldn't be giving that kind of decision making to them.

SPEAKER_04: 1:06:47

Absolutely not. We hear that they're 75 to 80% aren't showing up more than once a month. Anyway, so I don't know where that leaves us, but that was my last question. Last question. Uh, Jennifer, why don't you lead us out here by telling us all about the conference once again, some of the presenters that are going to be there. Just give everybody all the info out there before we wrap up here.

SPEAKER_00: 1:07:11

So, yeah, CPABA is really a different conference. It's not meant to come. It's supposed to help if you are a new BCBA or if you are a student BCBA or if you are in your career by three or four years. The topics are going to be discussed in a really big spectrum. So you're going to have the most extreme on one side to the other side, and then you're going to have everything in between. And it's not just in theory. It's going to be this is how we've applied it. One of the doctors is not even a specialist in one of the fields, and she's going to be talking about on one of the panels how she tried to implement a program into her clinic and couldn't do it. And here's all the reasons why. Here's all the problems. So that if you're trying to do something and you have these same circumstances, of times is it might not work for you. It's trying to help prevent us from implementing things incorrectly. It's trying to help us implement things correctly because other people are going to provide you with the training materials for your RBTs. They're going to provide you with how they implement it. So the discussion is about how as a BCBA or an owner of a company or a clinical director, how do you implement this? On the backside of this is for parents. And it's like we're trying to invite parents and say, like, you have a BCBA is telling you this what we should do are you aware that there might be eight different ways that you could be doing this and the way they're doing it is because they either that's the only way they know or that's the way that they feel that they can do it or that's the way their company does it did you know there's other seven ways you could do it and yes you could find a bcba or you could try to force this issue to get it this other way because the other thing that's really problematic is if you're doing something that doesn't fit the dynamics of that family or the culture or whatever it is in that family you're not helping the family And that's the other part of it. So we're trying to approach it from two different ways to bring accountability back into the system. And we're trying to help BCBAs who are on the ground, who actually have to implement the stuff, who don't know how to implement it because they've never seen it done because either they didn't have the mentoring or their company doesn't do it or they've never been exposed to it, or they have to modify it in a way that is not being represented in the research because of the parameters or the barriers that they're dealing with on the ground. And that's what this is about. So I hope we get lots of people. We're hoping that we get lots of BC CBAs and we're hoping we get lots of parents to try to help change the dynamics of ABA. So

SPEAKER_04: 1:09:29

just punch in CPABA to your Google search. It should come right up. The dates for the conference?

SPEAKER_00: 1:09:34

It should come up on it. Behavioral Live, by the way, is hosting it. For those who know, go to Behavioral Live. You can see it there. It's virtually, it's on the 11th and the 12th. Of October.

SPEAKER_04: 1:09:43

11th to 12th

SPEAKER_00: 1:09:45

of October. It's Friday and Saturday. And like I said, the conference, when you go on there, we're also offering really unique stuff like We have sex education for four hours where we have some of the best sex professors in the area. We're going to talk about how to do this so you don't cause problems. We have feeding experts who are saying, here's how you can implement this program into it so you can be educated.

SPEAKER_01: 1:10:04

That's so needed.

SPEAKER_00: 1:10:05

Yes, it's absolutely needed because the doctor will say, we're actually doing more harm than we are helping because of how we're dealing with this stuff. So we have sleeping specialists. So we're trying to also bring in areas where if you are out there practicing sex, how do you practice in these areas where these things have to be dealt with and you might have not gotten mentoring. So this is another, we're also bringing in, and again, it's not in theory. It is, here's how you do it here. I'm going to give you the paperwork. I'm going to give you the templates. I'm going to give you the worksheets. I'm going to give you locations. I'm going to give you the books. So it's, again, it's a way to actually take it from, from the conference right into practice.

SPEAKER_02: 1:10:40

So is this, um, directly for BCBAs? Is it for RBTs? Is it for parents? Who's the audience here?

SPEAKER_00: 1:10:46

It's for, truthfully, our goal is to try to, and that's why we have different price points to let people in. We're trying to get everyone to come in because I think if everybody's informed about this, then we start having an accountability system in place. Okay. Because if parents understand how a feeding program works and they're seeing it differently because someone's doing it, if an RBT is being told and only seeing their BCBA once every month, but they actually come in the conference and they can see how something's done and they see there's other methods that they could be using, they can put pressure on the BCBA to start putting them. Sure. The CBA is an organization and they're seeing, wait a minute, every doctor on that panel says, this is what I should be doing at one way or another in this format, but we're doing it this way. They can start pushing back against the owners and pushing back against their clinical directors and the funders. So the goal is, is that if everybody sees what truly exists and how it works in clinical practice, then that information can then help push back against some of these really poor practices. For example, maybe you shouldn't be doing 5% supervision. At minimum, you should be doing 20%. So

SPEAKER_02: 1:11:49

it's for everyone. It's for RBTs, BCBAs, parents. And then one more time, just where can they find it and what are the dates just so that doesn't get lost again?

SPEAKER_00: 1:11:57

It's October 11th and the 12th. It's on Behavioral Live website. You can go there or you can go to CPABA Conference. I found out a while back that there's a company called CPA. So you must be in conference. I did not know that. There are no association to us, by the way, but Behavioral Live has it. And also it is, you can go CPABA Conference, Clinical Practice Applied Behavior Analysis.

SPEAKER_04: 1:12:21

All right. I'm going to take us out here. Before I do, I do have to clarify something because we referred to the once a month supervisor Now, If that represents your 25% supervision, that's okay. I think we were finding that there were supervisors who, you know, kiddos were getting eight, ten hours a week, and then they're only being seen once a month. If you're doing that, please change your ways. Get out there at least 20%. Even some insurance providers with their stringency will keep you at 20%, so that's a good compromise there. Jennifer, it's been a pleasure. Thank you. I know you're going to be back. We can't wait to be part of the conference and check out what you guys are talking about. We'd like to wind down with a few recommendations here. So I believe you're saying stay training and learning, stay radical, and like we'd like to say at the end here, always analyze responsibly. Cheers, Jennifer. Cheers. Cheers, Dan.

SPEAKER_00: 1:13:15

Thank you.

SPEAKER_04: 1:13:16

Thank you.

SPEAKER_03: 1:13:17

ABA on Tap is recorded live and unfiltered. We're done for today. You don't have to go home, but you can't stay here. See you next time.