Parent-Led ABA Revolution Brew: Amy Jacobs-Schroeder & Happy Ladders on Tap, Part I

ABA on Tap is proud to present Amy Jacobs-Schroeder (Part 1 of 2):

Amy Jacobs-Schroeder is a highly respected professional in the field of Applied Behavior Analysis (ABA), and a passionate advocate for empowering parents to take an active role in their child's therapy journey. With nearly 25 years of experience in working with children with autism and other developmental disabilities, Amy brings a wealth of knowledge and expertise to the table. She obtained her Bachelor's degrees in Child Development and Psychology from California State University - Sacramento in 2001, and later a BCABA degree from the same university in 2007.

Amy is a true pioneer of the parent-led autism therapy movement, having switched to this approach 15 years ago after witnessing parents often sidelined in traditional therapy settings. This commitment led her to co-found Happy Ladders, an innovative online curriculum and coaching platform designed to empower parents of children with developmental needs, including autism, through play-based and parent-led strategies. She also shares her insights as the author of the Parent-Led Revolution blog.

Amy's dedication extends beyond her professional endeavors. She's a mother of five children and serves on the Board of Directors for Walk with Austin, a non-profit dedicated to supporting individuals with autism. Her experiences as a parent and professional have fueled her passion for making ABA therapy fun, flexible, and accessible to families worldwide, emphasizing the idea that parents are their children's best asset and should lead their developmental journey. More than anything,, Amy encourages all of you to sip slowly, enjoy your libation and ALWAYS analyze responsibly. 

Transcript

SPEAKER_04: 0:10

Welcome to ABA on TAC, 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 Tac. 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_01: 0:53

Alright, alright. Welcome back to yet another installment of ABA on tap. I am your ever-grateful co-host, Mike Rubio, along with Daniel Lowry. Mr. Dan, how are you?

SPEAKER_05: 1:04

I'm great. I'm I'm excited to be here. I know we were down to the wire on if we were going to record today, uh, but we pulled it through at least uh so far, and you were able to retain a little bit of voice with your tea, and we're good to go.

SPEAKER_01: 1:17

Well, so I'm glad you brought that up. I am certainly gonna try to speak more succinctly, not my strong suit. Um, but yep, the voice is a little down today. I've been working hard and uh the voice has a little bit of a strain, but that's okay. On top of that, since you mentioned it, um I also came into the studio to plug things in and had a broken cable. So, yeah, it came down to the wire today. I'm glad we were able to make it work. We've got a super cool guest uh for you today, who's gonna talk a lot about preparing families and parents for services, uh, something I don't think we talk about enough. Uh so but without further ado, let's talk to Amy Jacob Schroeder. Good morning, and thank you so much for your time. How are you today?

SPEAKER_02: 2:07

I'm great. I'm great. Thanks for having me.

SPEAKER_01: 2:10

You're very uh you're very, very welcome. Uh let's kick right off here. Um, we were talking before we hit the record button, and uh, you were talking to us about your project, Happy Ladders. Uh, but before we get into that, if you wouldn't mind hitting the rewind button and telling us uh a little bit about your background, uh everything you've done up until this culminating point of Happy Ladders, and then we'll take plenty of time to discuss the current project.

SPEAKER_02: 2:37

Okay. Well, I'm going to um date myself here because it goes back.

SPEAKER_01: 2:42

Um it means you're experienced. It means you're highly experienced.

SPEAKER_02: 2:46

Yes, very seasoned. Um we'll go with that. Um, let's see. I started uh in ABA back when I was in college. I needed a job. Um I found a job as a tutor. This was before RBTs, um, working at a school called the ABC School, um, which is based in Sacramento, and they still are around. And it was a um specialized um, what do they call it? NPS non-public school for children on the spectrum. And um started there, um, really loved the work, decided to um get my ABA certification um through SAC State. So this was like back in the day where you had to go to class. There weren't online classes. So I actually sat in a desk. Um, you know, this is this is post what?

SPEAKER_06: 3:41

What was this? You said your ABA certification was so at this time, was it the BCBA or what what was the ABA certification you were pursuing at this time?

SPEAKER_02: 3:48

Oh, see, I'm dating myself. Okay, so back before, back before I think you could even get um before the BCBA. I don't know when this how this came up, but anyway, there was an ABA certific uh certificate that was available through my university. And it was like, I don't know, an extra 21 units that you had to do in ABA. And it was super niche. It was something that was offered through the um psychology department at my university. The main reason it was even offered, I think, is because one of the founders of this ABC school where I worked um also taught at the school. And so I think that's how it started. And so um I got my certificate in ABA and later was able to get um board certified as that BC ABA. So I was I held the BC ABA for years and years and years um until it just got impossible to maintain, which you all may have seen some of that. But um, you know, at the time I was like a business owner and um you basically have to have like a caseload and a supervisor and all that to maintain a BC ABA. I let that go about five years ago, but that's a that's a bone I'll pick another day. So anyway, I um was a BC ABA for years. I worked um in-home, um, discrete trial programs, and I started to have um my own family um in my late 20s and really started to work at look at my work a little bit differently. I was running discrete trial programs and um thought, gosh, you know, I really wish that my clients could have a little bit more fun. Wish that they could learn the same way that, you know, my then toddler two-year-old daughter was learning through play. You're shaking, does this sound familiar?

SPEAKER_06: 5:44

Um yeah, finish yours and then Michael tell you about the whole thing.

SPEAKER_02: 5:48

So yeah, I wrote a whole story about this. I have a blog on our website and I kind of went through all the steps, but um, and I have a cute little picture of my daughter at the time sitting and and playing um at her little little table. But you know, I I just I really had a hard time going to work and having my three-year-old client sit and do these drills, um, and then watching my daughter learn so much through play. And at around the same time, this was like 2006, 2007. Um, my uh business partners and I were looking at a lot of the research that was coming out of UC Santa Barbara with Pivotal Response and this whole idea of play-based intervention and going.

SPEAKER_06: 6:26

Shout out to Schryman. I took her class at UCSD. Oh, cool.

SPEAKER_02: 6:31

So many great people came out of that program.

SPEAKER_03: 6:34

Yep.

SPEAKER_02: 6:34

Um, we were there for maybe the first couple years that they even ran conferences. So I feel like we just got like gems of information from Robert and Lynn. Yeah. Um they're now up here, uh up at Stanford, but for she is so careful mentioning Stanford around this guy.

SPEAKER_06: 6:52

Oh, he's a Stanford alum, and and we'll just talk for two hours about Stanford if you bring Stanford.

SPEAKER_01: 6:58

I'll go I'll get back to it. It's okay. Continue, sorry.

SPEAKER_06: 7:01

Sorry about that.

SPEAKER_02: 7:02

Well, we we have a um our second oldest is getting ready to go to Santa Clara in the fall. So I think there's a little bit of a rivalry there too. So yeah, I might be able to give you a hard time soon.

SPEAKER_01: 7:16

Well, if if it was Cal, you'd be able to give me a really hard time. Yeah, yeah, yeah. Anyway, anyway, we digress. Continue, please.

SPEAKER_02: 7:22

So so yeah, so through you know, looking at that pivotal response um research and um methods, um, and then also feeling the other the other big issue that I was dealing with as a program supervisor is I was dealing with parents that just were not equipped when we were ready to fade their programs. And they would resist and resist and resist. And you know, I got to the realization where it's like, we have not served them. We have not served these parents one bit. We have been working in a room separate from them for the last two or three years while they went and lived their lives and filled their time with, you know, stuff for other children, with work, with household chores, with whatever. And then we're saying, hey, here's your kid, you know, you've now, you know, we're done with our 20 hours a week or whatever it was. And they would really resist. And so um, I really started to look at that, like at what point did we fail them? And I feel like, you know, now looking back and and what I've learned over the last now 15 years since is that we failed them in the very beginning, you know, and I I think, you know, through Happy Ladders and through my work over the last 15 years, have really looked to kind of fix that issue right at the get-go when we first walk in on that first, you know, day of assessment. But anyway, so um in 2007, I started um along with two business partners, um, a company called Square One Autism Services. And um we called ourselves, we we called ourselves a tutorless in-home program because that's the best name that we had. Um best way to explain what we were doing. We were the only vendor in Sacramento, and ironically, there were like maybe 12 vendors in Sacramento at the time. Um, I think there's probably like 70 now or more. It's you know, that that blows my mind. Um so, but anyway, out of the the 12 vendors that worked with the regional center at that point um doing ABA, we were the only ones that didn't have tutors. We were the tutorless in-home program. And what we were trying to do was um really work, um, give each client some really quality time with a bachelor's or master's level. Um uh later they were certified certified as mid-levels, so kind of that mid-level position. Um and then also with a BCBA supervisor, um, and then giving parents a lot of strategies and support and things that they can do throughout the week. And um, so we typically would go in and work with kids four to six hours a week, and then then their parents were on their own the rest of the time. And it was a huge, a huge switch from what everyone else, I think, in the Sacramento area was doing at the time. And I remember going to these vendor meetings, which were small, and we had all worked together at like one point or the other. I'm sure you guys were in the field at this point where you know it was all a bit incestuous, and we had all kind of worked together or you know, been supervised by this person or that person. And so we all had to go to these vendor meetings every few months, and everyone was in the room. And I was still, you know, kind of on the younger end, more junior of that group. And I thought, man, they're just gonna eat us alive. They're gonna be like, what are you guys doing? How, you know, how are you running these AVA programs without tutors? Um, but they didn't. They were, they were, um, they left us alone. We kept doing what we were doing. And then when um the insurance mandate came through, kind of I can go into that later, but everything, you know, kind of changed um there.

SPEAKER_01: 11:00

Wow. That um so super interesting, just a bit of an aside so you know where I'm coming from. Um, I at Stanford, I uh was a developmental psychology major, and I had a chance to do a practicum at this really cool place called Bing School, which you might be familiar with, and it's still their developmental lab. Um the Walter Michelle Marshmallow study occurred at this school. Um Albert Bandeira's Bobo Doll study occurred at this particular school. So I was basically a teacher, and you would it was a you know amazingly well put together nursery school program, and they would pull the children out to run these studies, you know, depending on their age or whatever. And during this time, this is now back in um ninety-five, ninety-six, as you might recall, uh early in the nineties, Time magazine had done their feature on the best school programs in the world. And they had ranked Rezu Amelia as number one. So I got really well versed in this you know, Rezu Emilia, child directed, play-based approach to child development. And I loved it. I thought it was amazing, I thought it was you know mind-changing and revolutionary, and I got really good in this setting at working with the four five-year-old boys that run in these wolf packs and terrorize these dyads or girls, right? That's the way it looks. And I for some reason they would sit at my snack table and I could entertain them and engage them and uh colleagues there, you know, um uh very respectfully. You you you need to turn this into something else. There are other kids out there that need your confidence and patience when they're rambunctious. So I did. I went over to this um non-public school. It was uh a wraparound psychiatric uh wraparound service with psych psychiatric treatment. So the family got services, the kids went to school on site, uh, it was twenty-four hours a day that they could receive support. And it was a wonderful program, but the moment I stepped in there my first day, there was this stark contrast in the environment. I came from this idyllic center that was built for kids into this barren, very surgical, uh nothing on the walls because these kids had behavior issues. Uh and it was just such a stark contrast for me that you know this is now 1998. Uh ever since then it's been um my plight, you know, my my objective to try and and bridge that gap and and actually close that gap as much as possible, especially with early childhood intervention. Um I think that sometimes we can get a little overly specialized and it goes a little too far from what should just be you know play and exploration through play. So that that's where we're coming from. So it's very exciting to connect with you and be able to speak with you about um your ideas. I'm sure we're gonna be learning a lot from you today. So thank you.

SPEAKER_06: 13:45

That has been like, yeah, your plight like for the last 30 years, but definitely since we moved to the previous company, so the last ten years, um, because we worked more as peers than uh supervisor-supervisee, I know that that has been like your goal to try to make ABA or at least your application of ABA looks much less sterile and therapeutic and more just generalized.

SPEAKER_01: 14:11

I like to say that we um we combine uh ABA with best practices and early childhood education. And I think that's the best way to to describe what what I'm trying to do. And Dan's correct, about ten years ago, um during one of the outfits that uh was bought and sold and bought and sold, uh, way back in the happy days, um, we vendor to the regional center for early start services. And it you know that it became very clear that I could lead this objective now. And uh I posed the question to our um to our staff. I said, Hey, uh we use ABA to do autism intervention, right? So with insurances, if a child doesn't have this F-84.0, we don't get reimbursed for our services. Now these early star kiddos we're about to work with, what's their diagnosis? And oh well, they don't have one. Okay, so does that provide us an ethical quandary to consider at least just a little bit? Are we gonna keep doing the same thing we always do? Or is this an impetus for us to do something a little bit differently? And that's where the idea came and saying this could be child-directed, it can be play-based, you build a rapport, you build that notion of sustained attention, and then you can do all sorts of adult-directed stuff. You can do all sorts of struct structured learning. Uh you know, this idea that we had structured versus unstructured, and everybody saw this unstructured approach as sort of willy-nilly permissive, they can do whatever they want. It's like, no, it's not like that at all. In fact, it's actually a little bit harder, and you have to pay a little bit more attention because you have to read the room, you have to read the audience, and you have to turn just about anything reasonable into your program objective if you're good at it.

SPEAKER_02: 15:49

So yeah. Yeah, no, we definitely saw that, you know, when we switched, like I said, so when I started square one, um, you know, we switched my business partners and I from this highly structured binders discreet trial, you know, program where everything was planned and um every minute was was scheduled to um we went to shorter shifts. So we went to like hour and a half, two-hour long shifts of um really a lot of I don't even want to call it free form because it wasn't free form, but and and we did it ourselves in the beginning. So, you know, I was my first consultant because I thought, okay, we gotta see if this is even possible, right? Yeah. And we, you know, went into clients' homes with our bags of toys. Um, we really condensed down how many goals each client had and realized that there was a lot of work to do just within each goal. You didn't need 15, 20 goals. You really just needed like three or four that that could expand if the child was ready throughout the that reporting period, right? And so um we were, you know, I was very familiar. I knew those child's goals. I wrote those goals, I knew what they were. I didn't need to revisit them every session. Um I went in with toys that I thought I could work on those goals that that that child was going to show interest in. And and then the sessions just took shape. I mean, literally, we would start our session by, you know, we we had these huge bags um that we would take, and we all had just trunks full of toys and games and books. And um my kids were always like, What is all this stuff in this car? Why don't we get to play with this?

SPEAKER_01: 17:29

Um but because you won't put it back, and then I'll get to my session and I won't have it. That's why.

SPEAKER_02: 17:34

Exactly. Or I would steal, or I would steal their stuff and they'd look in the back and be like, that's my why's my game here. Um so but you know, we would just take in these big bags of toys and sit on the floor and wait for kids to pull out one toy that we thought, you know, maybe they're gonna show interest in this today. And it once they approached us, bam, we had a lesson and we could start pulling out whatever, you know, whatever that that skill was that we were working on um at that period. And so that's kind of where, you know, this this all came from. We were kind of doing this on our own. Like I said, we had the the pivotal response stuff to lean into. Um, but but a lot of it was just kind of like sink or swim. Um, but once we got kids interested, once they got interested in that activity, you know, then you can you that's the sky's the limit, you know, you can you can um do so much. And so so yeah, so that business um I was in for gosh, I think 15 years and then decided to exit after right about halfway through COVID. Um and we grew to we had about maybe 20 staff um mid-levels in BCBAs that went throughout the Sacramento area. And um, you know, they each had a caseload. Each BCBA probably had a caseload of about 25, 30 kids um, because we weren't seeing kids, you know, we were only seeing kids, you know, four to six hours a week. And so um those numbers may be a little bit off. I might be forgetting. But anyway, um, we realized that we could scale. We could scale a lot better, you know, with these numbers. We were also because we were empowering parents and giving parents things to do and kind of not creating a real dependency from the get-go. They weren't, we weren't filling all of those extra hours for their child. And so, um, and parents had to to do some work, and so they were also okay with uh fading out, right? They were like, Yeah, we're ready to graduate from you guys. Um, kids were making a lot of progress, and so we didn't keep, you know, kids as long. I think we kept them about, I think on average, like 14 to 18 months. Um, so we were just able to serve a lot of kids during that period of time, which was really exciting. Um in about, let's see, I forget when the insurance mandate passed here in California. It was like two thousand.

SPEAKER_01: 20:00

2012, I think. Yeah.

SPEAKER_02: 20:02

When everything, yeah, went all of our lives.

SPEAKER_01: 20:05

Right. It all changed.

SPEAKER_02: 20:07

For the better, for the worse. I don't even um all a blur. I do have a lot of PTSD from calling Blue Shield and trying to collect on some of those sprilly programs, um, sitting in there stuck in their phone tree for weeks on end.

SPEAKER_01: 20:23

Um you can only do two claims at a time, right? Only two at a time, and then you got to call back. Did they used to did they used to have that back then?

SPEAKER_02: 20:31

I think so, yeah. Maybe. Like I said, it was I've I've yeah.

SPEAKER_01: 20:36

You've put it, I won't, I won't remind you. You can put it asleep. You can forget it.

SPEAKER_02: 20:40

Leave it where you've archived a lot of that. Yeah, those were those were rough days. But um, so we we quickly figured out that we um wanted to work with Kaiser. We were we went in network with Kaiser, and Kaiser up here in Northern California has been um was was really great to us. Um and they've created a provider network, which is now it's they've had a few different names, but is now Catalyte.

SPEAKER_01: 21:07

Oh, okay. Yeah, we all I'm familiar with Cataly.

SPEAKER_06: 21:10

We're actually thinking about uh looking into Kaiser. We're not currently in network with them, at least down here. I'm not sure if it's in Northern California. I think everything goes through Easter Seals down here, and then they get uh like subcontracted through Easter Seals. Is that yep?

SPEAKER_02: 21:24

Easter Seals manages the provider network for Kaiser down there.

SPEAKER_06: 21:28

Uh okay.

SPEAKER_02: 21:29

Catalyte manages the provider network for Kaiser up here.

SPEAKER_06: 21:32

Okay.

SPEAKER_02: 21:33

So did you probably oversimplifying that?

SPEAKER_06: 21:35

Do you uh and I won't spend too much of the podcast talking about this because this is just specifically relevant for our company, but um, did you then credential directly through Catalyte or through Kaiser?

SPEAKER_02: 21:46

Initially it was through Kaiser and then and then through Catalyte because we were early. Um, you know, we got a call from you guys, these poor insurance companies were you know given this insurance mandate, and they're like, What's ABA? What are we supposed to be paying for? And how does it work?

SPEAKER_06: 22:05

And you know, um in the beginning, at least down here, it had to be managed by a licensed professional. And since there was no licensing in ABA, it either had to be managed by a nurse or occupational therapist or uh a doctor down here, because yeah, nothing there was no licensure in California.

SPEAKER_02: 23:04

Yeah, luckily we um had an LCSW that we had um we shared an office with and we were friends with, and like perfect. Um, so that worked out okay. But um yeah, so we started working with uh Kaiser and then they created what was then called the BHPN or and then is now called Catalyte. And so Catalyte, um through those first couple years, you know, they were creating their provider network, and um, you know, they had quite a few providers between the Sacramento and Bay Area. Um and they started to look at, and and I think that they're still probably one of the only health health insurance providers doing this, but they were looking at outcome data. And they were also trying to figure out like, how do we measure? These aren't apples to apples, like these guys are using this assessment, and these guys are using this, and these guys are doing this for reporting, and these guys, and they these guys are five hours, and these guys are 40 hours. Like they were just their heads were spinning trying to figure out like, how do we what are we even looking at and how do we judge, you know, yep, which programs are are are good over, you know, others. And so um they they tried to they did a lot of really good stuff to kind of manage all of those issues um so that they could look at outcome data a little bit more um in a little bit more balanced fashion. And they also started to do um parent satisfaction surveys across all of their vendors, all of their providers. And um through that, they found that they came to us um in like 2016 or 17, and um they were like, wow, you know, you guys are providing way less hours than some of these other providers, but your outcomes are just the same and sometimes better. And in terms of you know, skills that kids were acquiring, um we were obviously we were way cheaper, which you know is always helpful in that conversation. Um you were less expensive.

SPEAKER_01: 25:16

I'm gonna correct you on that. I won't call you cheap. I won't call you cheap. You were less expensive.

SPEAKER_02: 25:20

No, we weren't cheap, we were cheap.

SPEAKER_01: 25:21

More seasoned. You were more efficient, yeah, more seasoned, more efficient.

SPEAKER_02: 25:26

Yes, yes, exactly. So um, and then the biggest piece was they said, you know, they were looking at these parent satisfaction surveys and and they were positive. You know, they're finding that um, you know, parents who were going through our program felt pretty good about their kids' programming, about their own abilities and skills, and um, and they weren't running into those issues with fading. They weren't having parents like leave our program and go to another program. So I say all that not to say like, oh, we were so great, because I don't think it was because we were so great. I think that's just the model was proving itself, and we are kind of seeing that happen in real time. Um, we had just done the tutorless in-home programming because for one, I was tired of managing tutors. Um I did that for, you know, 15 years and scheduling and rehi, you know, hiring, and it, and it's it's a lot, you know, for anyone that's doing that. It it is a lot. And I think I'd learned a ton, but you know, there's there's a there's a limit to how long you can do that. Um, but you know, through this model, we figured out like, hey, this is there, there's there's something here. Um and at that point, um, Catalyte started to really um look at this parent-mediated, parent-led approach to ABA. And I don't know if you guys have followed their research, but they've they put out a ton of research. Um, Lindsay Sneed over at Catalyte. Um, I feel I she's like fighting the good fight. Um, because I, you know, I'm not, I'm not, I don't have PhD. I don't have the access that Lindsay has um to all the the studies and and things that she can do. I'm just, you know, a mom and a, you know, a business owner that's been sitting on the carpet for years recognizing patterns, right? And going, wait a minute, this this seems to be working, and that's not working. Um, Lindsay has done a great job of um really pushing this whole parent-led, parent-mediated idea, um, publishing some really great work around it. And um, so we've seen parent-led because of that, and because Kaiser's really a huge provider up here in Northern California for a lot of kids. Um, we've seen this parent-led idea really explode. And um so fast forward to today, that's kind of you know how this whole idea of happy ladders, which is my current project, came to be, is I wanted to take everything that I've that I've learned um through this parent-led approach and see if we could apply it to early intervention. And we are working with kids within the um California State Regional Center programs. And so there's there's 21 regional centers in the state of California, and um, they each manage for the zero to three or zero to five, it's different for each regional center, um, manage all the early interventions. So the developmental therapy, speech therapy, occupational therapy that a child may need. And um, they also often provide for what they call as needed ABA. So it's for kids that are kind of um identified as probably having an autism diagnosis, but not yet diagnosed or recently diagnosed and maybe waiting for insurance funded ABA services, um, they can get that support through their regional center. And um, and that's where Happy Ladders comes in, is we've created this um app where parents can um get on, and there's um we have developmental skill assessments um that then tie to activities parents can do at home, kind of in their own time to address their child's developmental needs. Um, we've seen some amazing progress. We've um been, the app's been live for about two years now. And um we've had some kids just graduate that were working with us for close to a year or a little bit longer, um, you know, that are going into preschool. And these parents, just the evolution of these parents and kind of what they've learned over the course of that time is really cool too. And um in the app, we also have a private parent community. So parents can, you know, chat and kind of in that safe environment. Um we have a bunch of resources and trainings available, and we also look at, you know, the the behavioral piece, challenging behaviors, toileting, um, all of that. And um what I like to call heavy ladders is kind of like it's a it's pre-ABA. So we get kids with all sorts of diagnoses, so global developmental delays, Down syndrome. Um, maybe they just have, you know, a speech need um at this point. But I would say about 70% of the kids that we do get referred um either have an autism diagnosis or will most likely get one in the near future. And so this happy ladders ends up being for those parents kind of their first introduction to um, you know, how to work with my child. But it's in a very developmental, play-based, um, very self-paced um manner. So we're not trying to overwhelm them. We're just trying to give them some useful skills and and help them kind of get some momentum um and get some confidence in working with their own child um before we set them out to you all.

SPEAKER_01: 30:53

Nice. Well, you've given us a lot to unpack there, Mr. Dan. You got some stuff? Sure.

SPEAKER_06: 30:59

Um let's see. I'm trying to think if we should go back to what you said earlier. Uh let's let's talk about the happy ladder's parenting piece first, um, since that's the last thing that you you talked about. About, I don't know, maybe 10 years ago at our at our previous company. Um, we started with the parent groups. Um, and this is kind of right along the lines of what um what you were talking about is that ABA historically, right? Like even back from the DTT days, it was like you go in this room and you can't have the parent in there because they're gonna be distracting the the child and you have to teach the skills, right? So it it kind of separated the the parent and the and the child. And it's funny because you go back even farther to the Lovas study that everybody uh references when they want to justify their need for 25 to 40 hours a week. They you know justifies study that happened 40 years ago. Um, but everybody just conveniently forgets.

SPEAKER_02: 31:51

They're a different set of kids, most likely.

SPEAKER_06: 31:54

Um the comprehensive, that's not the word, um, the intensive group also involved parent training, which it's just like, no, they just had a lot of hours, yeah. But they also had parent training.

SPEAKER_02: 32:04

Yeah, you're right, that is overlooked.

SPEAKER_06: 32:06

I I digress uh back to the point of the importance of parent training. So we at our company were looking at these situations, and like I mentioned before, we um went on air that we had a pretty idyllic situation at our at our previous company. We had a capitated contract, which was just amazing. So instead of having to bill for our services, we basically got paid on the front end, um, which was awesome, but it made it so we didn't have to scrounge for hours and hours and hours, and we were also able to like do admin time and paid admin time, and that was actually used pretty productively. Um, and we were able to hypothesize things and talk with teammates. And one of the things that came up, I don't know, 10 years ago was this idea of parent involvement. It was always talked about, but it was never really focused on. And we would notice we'd run these social groups, and then the parents would just be sitting out in the waiting room, like, Yeah, can they be involved because of HIPAA? Because they're seeing active treatment, uh or we'd go to some home sessions, and sometimes parents would be very actively involved, and other times they wouldn't be. And we're like, we got to get these parents um together um and and talking about it and and learning from each other because number one, I'm not a parent, so I don't understand what it's like to be a parent. And we've always had the mantra ABA from the lab to the living room. So it's obviously from skinner and labs and even Lovos, taking something from the lab is gonna work totally different in your house with grandma there and sister running in and out, and somebody late for swim practice, and you gotta go pick them up. So we were like, let's try to get all of these parents involved um and help them become the participant of the treatment uh to some extent, because at the end of the day, they're the ones that are gonna be either exemplifying our services or detracting and undoing everything that we just taught. Um so we did that, what about 10 years ago, and that really took off. And um, my goals kind of changed, and and honestly, it sounds kind of cliche, but we learned as much, I think, from them as they did from us, and our services changed so drastically um over our time learning from them. But just the the value of hearing it from another parent, um, I think was so you know, a lot of these parents just feel so isolated, and maybe their other friend that has a three-year-old kid who doesn't have some of these behavioral challenges. They're out playing soccer and they're going all these places, and this parent, if they take their kid out anywhere is having meltdowns and running across the street, and they're feeling like nobody understands them, so being able to hear it from other parents kind of took a little bit of the weight off. Hearing some of the strategies, being able to talk about it, getting access to the resources. Um, these things, those were kind of our three pillars of the parent group. It was uh I think it started as an eight to ten week curriculum, and some of them lasted for years because when we were done going over the strategies, we would continue to meet weekly and chat about it. And we would give a lot of advice, but sometimes it was better taken from the other parents rather than the ABA professionals because again, they're living it. Um, it morphed into a dad's group. Um, so maybe five years into it, you know, that it was typically the moms that would come, not always, sometimes it would be just the dad, sometimes it'd be both parents that would come, but probably 70% of them would be just the mom. And they were like, My husband won't listen to me. I tell him everything that you tell me in parent group, but he won't listen. So we started a dad's group, um, and that was amazing to kind of get that different perspective. Oh, yeah, because it's it's interesting because just because they're not necessarily physically present doesn't mean that they don't care. Um, they're out, you know, potentially supporting for the therapies and things like that, and expected to come home and somehow know the strategies that were taught at home when they weren't there. So it's just really interesting to get that dynamic um and see some of these dads. We worked with a lot of military families that, you know, were military dads and people that have been to war and like just break down and talk about some of these things that were so important to them and their first IEP. Um, so I'm just kind of covering a lot of ground here, saying that these parent groups that we started, I think resonate a lot with what you're saying and is still so underutilized in the ABA service delivery model.

SPEAKER_02: 36:34

Yeah. Yeah, yeah, no, I I I think it's huge to to touch on a few things that you said. Um within the Happy Ladders app, like I mentioned, we have this private community, and um sometimes parents will answer other parents' questions. You know, so I have some veteran parents on there, um, and they'll chime in and help the the newer parents and have some good advice. And it means so much more coming from them than it can from this going to from me. You know, I I just it they've walked the walk. They just they have a credibility that you know that that I don't have. And I have some credibility because I've been doing this a while. I'm a parent myself, but I'm not in it right now like they are. Um and um so I I really, you know, it is, I think that that parent-to-parent support is pretty invaluable. And then dads, I mean, I would love um to be able to access dads more so because they do, you know, stay quiet. One thing that we do is we have um within the app, it's kind of cool because we have the ability to bring in multiple um caregivers.

SPEAKER_03: 37:45

Okay.

SPEAKER_02: 37:45

So, you know, we have um, you know, for the most part, I would say mom is the main one using the app. Sure. But she can invite grandma, she can invite babysitters, she can invite dad, so that everyone can have access to that child's profile and what they're you know, what activities they're currently, you know, recommended and what they can do, and and they can all, you know, take some simple data and and things. And so um, you know, that's really nice to be able to give dads that access, just even if they just log on just to get a sneak peek, because you're right. I mean, for or for whatever parent is not present, they do feel um, you know, out of the loop. And to get in the loop is is is a lot, you know, and then there's there's a lot of you know, potential criticism and defensiveness there too um that you know comes up. So yeah, you know, I I think my I've thought about parent training a lot over the years, and I, you know, did it kind of in that that typical way early on. We used to run um 16-hour parent training courses.

SPEAKER_06: 38:50

Okay.

SPEAKER_02: 38:50

Um, parents would have to do this course in order to be eligible for ABA. I remember that.

SPEAKER_06: 38:56

I remember those days. You guys remember that? Oh, yep.

SPEAKER_02: 38:59

So we would have to find um well, we would use our office at the time, or if we were doing uh parent training like in an outline area, we'd have to go find space in an outline area for four Saturdays in a row from nine to one. And I the consultant, the BCBA that ran those for me, I don't even know why she did it because um it was it's a thankless job. And she was like basically she was running around town trying to find like meeting rooms in the nearest grocery store. I mean, that's kind of what we had to do in order to be able to provide parent training courses, you know, into some of these rural areas where we were working so that these parents could then get access to ABA. And it wasn't necessarily access to our program, it was just access to any program. And um Yeah, yeah, I remember that. So I had someone wonderful, yeah, yeah, that would run these programs Saturday mornings, you know. But the thing is, it's like you have to have so many parents sign up in order to bill for it, right? Yep, and then um people cancel last minute because they deal with sick kids, childcare, transportation, all sorts of stuff. And so the amount of parents, you know, we'd get like 10 signed up and maybe two would finish.

SPEAKER_06: 40:10

Yep.

SPEAKER_03: 40:11

Oh man, yep.

SPEAKER_02: 40:12

After four weeks. Um and and we were taking them, you know, and rightfully so. We it was boring. Yeah, you know, I mean, we were just like, and this is we were just giving them the curriculum that we were supposed to, right? Which is like basic ABA principles and principles of reinforcement and shaping and fading, and all those things are great. Like I I live and breathe all of those ABA principles, but I do it through my everyday life, you know, which is a lot more exciting and interesting. Than in a binder. Yeah. You know.

SPEAKER_01: 40:45

It just seems like such a gap between those terms and you know, a parent sitting in a meeting room in a grocery store who's there to try to get these services. And it just seems so esoteric, it just seems so hard to reach. But to your point, we all love it. We know it works. And then to the greater conversation we're having is how to make that accessible to parents, how to make it interesting, how to make it practical. Um, you you took me back to a little PTSD earlier, and I remember that being a big part of our assessment. You know, here we are offering you services. Do you have a space in your home that is isolated, that is separate, that we could provide our services in? I cringe saying that, even just now, you know, hypothetically speaking, it's like, oh man, we just we were so we were so wrong. We were so well intended. Yeah, yes, but we were so off.

SPEAKER_02: 41:37

Both can be very true at this time. Yes.

SPEAKER_01: 41:39

Yeah, no, I I know I was well intended. And having come from the whole you know child development tradition, it was very weird for me to ask that question, but this is what we're doing, and I've read the studies and I know this discrete trial stuff, and it we have to have a table. It took me years to realize that the table was a nice thing if the kid sat, and guess what? I didn't need the table. But there were so many things that were part of almost this rigid recipe that we created. Um, that well, we created that was given to us empirically validated, right? And so we had every reason to trust it, and and we still have every reason to trust it, and then what we're talking about here is that needs to look a little differently. You don't have experimental control in somebody's living room. So you're gonna have to lean on the fact that these things worked under experimental control, and then your margin of error is gonna be a little wider. But guess what? If you do this, it can still work. And then to your point, Amy, if you do this in a much more, for lack of better phrasing, naturalistic way that looks at the development of the whole child, you'll probably inform yourself a little bit better ongoing. It's a much more dynamic approach, a much more dynamic feel than what I think we were, at least I was originally trained on. Even in stark contrast to my child development knowledge. Um, you know, I had to trust the science, and I did, and I'm glad I did, and I'm also very glad for all the evolutions and transformations that uh I've undergone in, you know, in my career, thanks to mentors and you know, good people that I get to talk to and learn from. Uh, but it's it's it's so interesting to talk about all this because again, we were so well intended, and we certainly still are. We were going above and beyond, you know, bending over backwards to find, to your point, your story, meeting rooms and grocery stores to get people these services, and yet we were still pretty far apart from making it accessible. So very glad for a for an app like yours that continues to heighten that accessibility.

SPEAKER_06: 43:33

What you say though makes um makes me think about what you said earlier about the how when Early Start came over, you were saying since the individuals weren't diagnosed, uh, you know, typically, at least currently, the way that ABA services are are delivered, the people, at least under the medical insurance, need the the ASD diagnosis. But I mean there was never really that correlation, right, between ABA and ASD. There was never like, oh, ABA is better for ASD or worse, it's just it happened to be the one entity that was used for ASD. Like you can use ABA just as well for somebody without ASD as you could with ASD. But it's interesting thinking about it because if you think about like, especially when you get into the templated materials or things like that, you know, like, oh, it's gonna be real visual heavy, you're gonna use a lot of routines, you're gonna use these things. These aren't necessarily ABA strategies, these are straight out of the ASD curriculum. So made me think about like when you initially said that, I'm like, why does it matter if they have a diagnosis or not? Yeah, it really shouldn't matter, but in the actuality of how it's implemented, it it really does because so many of our templated curriculums are devised from the ASD piece.

SPEAKER_01: 44:41

Well, Amy, you can probably speak to that a little bit. Um, and I I kind of use that phrasing. Uh, we can become overly specialized. You keep using the word, in my opinion, you keep using the word developmental. Um explain that to us a little bit in terms of of how you see it. So you're kind of using developmental as a sort of wider whole child framework that can be used here. And then, you know, I I make the joke sometimes, you know, but we ever have Velcro less ABA. And this is sort of a jab at, you know, uh the the nice laminated one by one icons that uh can be very, very common in our programming. And I'm not trying to be super critical of that as much as I'm saying that seems to be sort of our niche.

SPEAKER_05: 45:20

Like if it's are you questioning hard on the card?

SPEAKER_01: 45:23

Yes, I am. You don't need velcro.

SPEAKER_05: 45:25

Um it has to be hard on the card.

SPEAKER_01: 45:28

The point being, there's these there's these things that that you commonly have to have uh visual schedules, uh, you know, and again, I'm not letting criticism as much as we've created these specialized materials for these specialized services. I get the feeling sometimes we go too far in that direction. You're I get the feeling pulling in the other direction and saying, can we have a more general developmental framework? I threw a lot at you there. Can you speak to that?

SPEAKER_02: 45:53

Yeah, well, I think um the the best way to answer that question might just be to tell you kind of give you a snapshot of of what what our program looks like. Um being implemented, right? And and I don't see it. So that's the craziest part because I don't go in and see it. I don't go into these people's homes. They work through the app. I see their their I see the outcome kind of on the back end. Um and we do have um virtual support available to parents as well. So I do talk with some of them when they do have questions and things. We have like an onboarding meeting initially. Um but you know, and Happy Ladders isn't, like I said, I call it, you know, kind of like a pre-ABA program, but it's not a true ABA program. But the way that these programs, these activities that we recommend are getting implemented are just in people's living rooms, kind of in the time that parents have, there's there's no, you know, special tools, there, there aren't any binders, they aren't taking any crazy data. Um, you know, I learned early on that if if there's one consultant working with a child, you don't necessarily need to take data on every single trial because the consultant's there for it. You're not communicating it to anyone else. You do need to test it.

SPEAKER_06: 47:16

I got reported to the board for that by a new BCBA. We said the same thing. He was so appalled that we said you don't have to take data on every single trial. He reported me to the board.

SPEAKER_02: 47:28

Yeah. Yeah, yeah, yeah. I mean, they didn't care, but yeah, watching um our previous when with when I ran square one, um, you know, we would hire consultants that came out of a more discrete trial structured ABA environment and put them in ours. And they were often really uncomfortable for like the first three months because they were like, Well, I that that I don't have where do I write it down? Where do I record? What am I? And then after the first three months, we talked to them, they're like, This is the best thing ever. I mean, they were just like, I they're just they felt like they could do their jobs, they could make changes on the fly. They didn't have to make a recommendation and then have a meeting and then change the paperwork and then get, you know, they could just go, well, this lesson isn't quite driving the way I want it to to meet this goal. So I'm just gonna change it. And they did, you know, and that that to me was like, well, that's being truly a BCBA, is identifying what's happening, what's working, what's not, and what you can do to tweak that and using your ABA skills to to to do that. And so um, you're right. I think there's a a lot of kind of ASD and and autism therapy that we've infused into ABA. When you pull all that out, I mean ABA is still great. ABA, you know, as far as like you guys mentioned, the critics earlier, you know, ABA really isn't the problem. ABA works on all of us. I use it on myself, I use it on my, you know, my own family. It's just how I think, you know, it's how I frame a lot of my own goals and chores and all sorts of stuff. Um but anyway, so so getting back to, you know, kind of what if you distill down, you know, how do you teach a skill to a child and how how do you show that you've taught that skill? Well, you practice it. You need you need a framework, right? You need a reinforcer. You you know, we need some way to reinforce that skill so that they continue to do it. Um, our parents kind of through the course of working on the activities, start to understand this whole idea of shaping and fading, um, expecting a little bit more, giving a little bit less help over time. Um but in the end, they're the ones that say whether or not their child can do this skill. Can he stack five blocks? Well, yes, he can. Okay. I don't need yeah, that's always been the stacks or days and days of data to prove that you've done that. He can stack five blocks. And you know, what we found too is that parents are really um, they do not give their kids more credit than is due. They don't they don't, you know, if anything, I feel like when our parents go in and do the assessments when they first sign up for Happy Ladders, they underestimate what their kids can do. And in a way, I think that that's a feature, not a bug, because what happens is those first couple activities that they get in the app are easy. And so they get to understand the format and get to check off and say, oh, that's mastered, that's mastered. They get some early momentum, which we all know is is super helpful. Um, but parents don't overestimate what their kids can do generally, they generally underestimate. So they're they're pretty good critics. Um and when we're dealing with, you know, the skills that we're teaching through Happy Ladders are all of the the skills that you would typically see um from zero to 36 months. And we're just teaching them. So it's not like there's anything, there's there's it's pretty black and white, you know, as far as like can they can they do it or or not? Um and we just try to keep it like I love the phrase super simple. You know, we're always just trying to simplify, simplify, simplify. And um, you know, we're just moving parents and kids kind of through these baby step skills. And um, it's amazing, you know, what they end up doing in the end and what they are able to teach their kids.

SPEAKER_01: 51:30

What you're describing reminds me of uh just really well put together like early childhood board games that have a set of rules that you can follow, and then you can just play with these things in a million different ways. And I imagine that's what ends up happening in the living room with your activities is everybody's got a little bit of their own interpretation of so you have a a target and objective, and I think people are clear on that, or I'm hoping they are, but then how they get there is gonna look a little different. And somewhere in there is the notion of play. And I think for young kids, that's so important, and something that unfortunately uh very earlier in my very early in my ABA career I realized had been lost. We were going through these regimented, pre-planned, and I understood the structure. I understood the importance of of having a plan, of having some sort of uh semblance of a curriculum toward these milestones and and and these, you know. Task analysis analysis, and and then one day I'm like, man, we're breaking this down into way too many steps. Like by the it was almost like um it reminded me of working on my car and you're taking something apart, and all of a sudden you see a couple springs fly out. You're like, oh man, I don't know where those are gonna go back in. And it's like we were breaking things apart so far that putting it back together was so difficult, and it was often just so decontextualized, and it didn't make any sense anymore. Um, I don't know.

SPEAKER_06: 52:52

I remember board games, right? It was like, okay, so uh say your turn, and then the person, okay, now you say my turn, okay, now you can take your turn. Now you say your turn, now they say my turn, and it's like, what are we even doing anymore?

SPEAKER_02: 53:04

You know what I realized through all of that once I got a few years out of it, is that a lot of that, you know, how small everything was broken down and how systematically everything was taught. I feel like we were doing more for the RBT than we were doing for the child.

SPEAKER_01: 53:21

That's a great statement.

SPEAKER_02: 53:22

Felt like we were doing it for the child because that's the only way they would learn. But I think that in actuality, we were doing that for the staff because that's the only way that we could run a consistent program across five different people that were rotating. Because that is that is a heavy lift. And like you said, once again, kind of teasing out the AVA from the ASD treatment, you know, but there's a lot of things that we ended up doing, you know, well-intentioned, thought for the child, but I think it was for just the the ability for the thing to even work.

SPEAKER_01: 54:02

Well, and this episode is working very well, although this concludes part one with Amy Jacob Schroeder. Please do return for part two and always analyze responsibly.

SPEAKER_00: 54:15

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.