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

ABA on Tap is proud to present Amy Jacobs-Schroeder (Part 2 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_02: 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: 0:52

Alright, alright, and welcome back to yet another installment of ABA on tap. I am your ever grateful co-host, Mike Rubio, and this is part two with Amy Jacobs Schroeder. Enjoy. And the larger the outfit, the the more employees or RBTs or tutors people had, the more standardized those programs became, which from a standard operating procedure perspective is incredible for a company. And then it completely obliterates the idea of individualization at the same time. So again, super good intention. And and I I think you make a very wise, uh, very astute observation there. It was more about how can we train all of these young professionals to run these systems, and in there we can become more efficient by preparing their visual schedule, preparing their token economy whether or not, or their star chart, whether or not we think the child would benefit from a token economy. Um so all these things become standardized, and at the same time, uh the individualization starts going out the window. That's a really good way to put it.

SPEAKER_03: 2:00

I mean, I I trained at the first company for what, 10 years, and I remember the second to last day of training was on materials, and we would make the infant startup kits where you would have the double laminated folder on one side you'd have the schedule, on the other side you'd have the choice board, you'd have the first then strip, like and this is what you would you would bring in that that standardization. And it it's interesting because you've used the analogy of McDonald's. Um and I heard a private equity uh a private equity, an owner of a private equity company use that in their uh that runs the ABA, says that that's use that like that's what we want to be. We want to be the Mc uh we want to have McDonald's, which makes sense because like okay, anywhere I go to McDonald's, I'm gonna get the same thing. But you brought up the good point is do you really want to be the McDonald's of healthcare?

SPEAKER_04: 2:49

Yeah.

SPEAKER_01: 2:49

Is that is that is 30 million served?

SPEAKER_03: 2:53

Is that is that is that what we want? And is that is that what it is? You brought up a good point too. Um, Amy, I think about the parents not overrepresenting um their kids. Um, I think is humans were hardwired to notice what people don't do. You know, you ask your kid to do 15 things, they do 13 of them. You're not gonna remember the 13 they do, but you're gonna really remember the two that they don't.

SPEAKER_04: 3:16

Oh, guilty.

SPEAKER_03: 3:17

When we would do FPAs, I can't tell you how many times I'd ask, how does your child do with following instructions? Oh, they struggle. Okay, what percent would you say they follow instructions? 0%. Really? 0% of the instructions they follow.

SPEAKER_05: 3:31

It feels like, yes.

SPEAKER_03: 3:34

Like, what if I told you I bet you money, and I've never met you and your kid, I'd bet you they follow at least 99%. You just don't notice it.

SPEAKER_01: 3:41

Like, we're here, we're here to talk about their deficits and how much service you're gonna give me. So they follow instructions, zero percent of the time.

SPEAKER_05: 3:48

Zero percent, yeah. So you guys are touching on generalization too, and I think that's that's another, you know, and you're you uh are probably seeing this or have seen this also, is this whole idea of having to teach generalization. Um, when if you're working in a in the middle of a family room and you know, with some of our activities, yeah, there's multiple people present. Um, we have siblings, we have older siblings that that watch parents implement activities, happy ladders activities, and so they'll start doing it. Yep. So, because there are a lot of them are just little social games, right? It's like, you know, this the skill may be um teaching your child to respond to look at you when you call their name. So we create this cute little activity, this little game called Hey Sarah, um, where the parent or whoever runs around the house and hides and says, Hey Adam. And you know, we're trying to get Adam to look. And when Adam looks toward us, we make a big deal and we start close to Adam and then over time we move farther away, you know, and so there's so much generalization built into that implementation over the few months that a parent might work on that skill because they're doing it, the other parents doing it, you know, brother, little six-year-old brother's playing a funny game and doing it down the hallway, you know. And so, um, and then the parent understands that they're trying to get the child to respond to their name. So they're also calling their name, you know, all the time.

SPEAKER_01: 5:10

Um the way you just contextualize that is so great. Uh, response to name is we got rid of that program.

SPEAKER_03: 5:17

We changed it to response to auditory stimuli.

SPEAKER_01: 5:19

Yeah, so the idea that the joint attention, right? So you're you have to orient to sounds, and your name is a really important sound on that list of a bunch of sounds that we would never be able to conceptualize fully, whether we did our best task analysis or not. We don't know what sounds are gonna come up, but the idea that you're gonna orient to a sound, and the way you pitch that with the repetition, where it's a game, it's almost like an expanded version of peekaboo with your name. That's incredible. That that is oh, I'm I'm so excited to hear about something like that. Because anybody could just take that that very simple idea and run with it and have fun and build the very skill that that's that's trying to be addressed in a way that's now jovial and involves some level of of uh you know bi-directional rapport and exchange.

SPEAKER_03: 6:08

Not this you know what ABA's gonna do with that in the change in criterion, though, right? They're gonna do it at six feet and then seven feet, and then eight feet, and you have to do it ten times at each one before you can move to the next foot across three supervisor or across three tutors in two different settings.

SPEAKER_01: 6:24

Um again, another example of just so well intended, and and then we we kind of shoot ourselves in the foot sometimes by making something um just overly analytical, I guess, is the point.

SPEAKER_03: 6:36

And then if you don't respond, you have to prompt the response, of course.

SPEAKER_01: 6:39

Again, these are all really super good things that we were trained on, and then to our conversation here, um it it's it's conceptual. How it actually plays out, it may play out perfectly that way, usually doesn't. You usually have to adapt, you have to pivot, you gotta shift, you have to do something that then tests your conceptual understanding of the concept you're trying to put forth and see if you can adapt. Again, it's that margin of error that that uh you know, at the beginning of my career, almost 30 years ago, yeah, it was you know, Lovos used this table and this chair, and they did it this way, and this is the way you're gonna do it. And yes, it it it worked, and then it worked well enough that it behooves us to then recontextualize that very framework to bring it up to speed, right? And that's what you're talking about, Amy, is now a simple game of where's Amy or whoever it is. And yeah, we're playing peekaboo with sounds, uh, not just the visual orientation, and and we're really bringing together both auditory and visual components of joint attention. That that's incredible, incredible.

SPEAKER_05: 7:41

Yeah, you know where I learned a lot of that is um is watching some of my um early RBTs, like my favorite RBTs, and you guys know you've had these RBTs that are just magic, and they just get it, they just intuitively get it. And when assigned a child who does not go by the book, yeah, you know, and I've had few, I still I'm still in contact with the particular client I'm thinking of. Um still friends with his mom, he's now in his 20s. Um but he would not, I had this beautiful binder, beautiful lessons, beautiful materials. And I was like, I don't know, I was probably 25 years old, and you know, here I go in. I'm I'm the the you know, the program manager, and and I have these two RBTs that were like my age or even older than me. One was quite a bit older than me. And um, you know, I've got all the stuff and I'm ready to go. And this kid was like, forget that. I am not sitting at that table. They lived way out in the country. He wanted to bounce on his trampoline all day. And I was like, We can't you okay, so bring him back to the table. Right. Like, you know, and it was beyond like he wasn't even gonna tantrum if we tried, it just wasn't gonna happen. And um, so his RBTs luckily were incredible and they just adapted and they do lessons out on the trampoline and they try so hard to use all my materials and run all my lessons, but pretty soon they they like the bind, the binder got lost somewhere in this big old house and probably hid it. Um, but they taught him so much just through play and creating these games for him, and he loved them. And I mean, he kept these these tutors for for quite a while because they were just, I mean, they were so attached to him. And and and they and that's who I learned from. I was supposed to be the one, you know, running this program. And I would just, I just threw my hands up. Eventually, I just go out to the this particular client's house and just like watch them and see what they were teaching them that day because they weren't doing anything that I had set out.

SPEAKER_03: 9:55

Was it uh oh, I'm sorry, I'm sorry, Amy.

SPEAKER_05: 9:58

Yeah, so anyway, I've just you know, I I think that there's there's so much to be learned just in those those kind of like sink or swim situations. You gotta figure out like how am I going to engage this child so that they want to hang out with me so that I can, you know, start to teach something.

SPEAKER_03: 10:15

Yeah, I feel, and I mean, like I said, at my previous company, my previous company before that, I was the trainer, so I've probably done new hard training for RBTs the last 15 years. You mentioned like it kind of incetuous. I feel like every RBT in San Diego has been either trained by me or trained by somebody who's been trained the six degrees of separation. Um but I bring that up because I think it was Porsche. You might remember specifically. Um, but we had a guest on recently that talked about how she intentionally does not uh when she advertises for positions for RBTs, intentionally does not uh put RBT in the position and does not look for RBTs because it they come with like the the predisposition of the structure and all this stuff, and she's like, I just want somebody that can play with kids and handle behaviors. The rest I can teach you all the rest of the stuff, but um yeah, and that's I think what we might actually do when we're looking for another RBT now is we might not even look in the ABA field, like we'll train you the rest, but can you play with kids? And are you okay with behaviors?

SPEAKER_05: 11:21

Yeah, yeah.

SPEAKER_01: 11:22

Those RBTs you're talking about, um, you know, you lend them a little training in the principles of ABA or or individuals like that, and then you you have to appreciate how closely they must be paying attention to the child to be able to figure these things out, and I think that's where we can become overly structured. Uh and I'm you know clearly I'm partial to being a little bit more child directed and and and you know uh loose and working on the incidental off of the incidentals, but um I do think that when we come in a little too programmed, a little too curriculum-based, we watch a little bit less because now we're insisting that the child has to do this. Um where if we take their lead, then we have to watch more closely to turn anything into some appropriate, you know, uh addressing or objective toward the target. Um what's you know the the middle ground? That's what I've been trying to figure out. And I I do think there's a I've been trying to define for myself how far do I take this child-directed play-based stuff before we identify, quantify some level of rapport, if you will, uh, or instructional control that now allows me to shift gears and go, okay, Johnny, today I'm bringing in all this stuff, and I'm really gonna compel you to sit next to me. And we should have built enough of a relationship at this point that I can do that again, still maintaining a child-directed approach, but knowing that I've done this, I've I've put my time in, I've front-loaded, so now I can expect you to naturally sit next to me and I can do these things that are a little bit more structured or planned. Um I'm still trying to define that shifting point. I know it happens, um, and it's hard. It's hard to teach that. It's hard to tell you know younger professionals, look, you're gonna do this open-ended approach for a little while, and then the more you do this, the more you're gonna find that child right next to you. At which point, sit down and do something. Sit down and do something that you pre-planned. Um, you know, it it's it's hard to quantify that, but that's what I'm after is put the time in, pay attention at first, build that rapport truly, understand how that shifts over into instructional control, the idea that the child is now intrinsically motivated to interact with you, and therefore they will provide you the responses you're looking for, or they will provide you the uh sustained and joint attention for you to demonstrate those skills that you need them to then uh express. So yeah.

SPEAKER_05: 13:46

Yeah, that's a great, that's a great question. That's a great point. I think for me, I've always I've always leaned into the the developmental skills and really looked at where are they developmentally, you know, in terms of what what should the expectation be. So if you you know have a a three-year-old client who's you know scoring mainly in that six to twelve month range, it's gonna be really hard. Yeah, you know, right? That that's that that's a big ass to ask them to come sit with you and do something structured because generally that's just that's not where they're at developmentally. Right. Um, you know, but once you get to a point where you're more in that like 12 to 18 month range and they might be like sitting and looking at a book with you for a few minutes and doing some, you know, some pointing as you're labeling things that you see. And these are some of the activities that we have in Happy Ladders too. Well, now you've got you've got yourself a little bit more of a structured lesson, right? You've got a child who will come to you and sit for a minute or two at a time and comply with some receptive instructions. Um, and then you can can build from there. But um, I think for me, that's why I just I always go back to where they are, where what what developmental window are they in? And then then I really know whether or not they're they're ready for something. Because I think that that's something that I overlooked early in my career is you know, having kids sit at a table, like you mentioned the table earlier. Um having kids sit at a table for 20 minutes at a time, if they are still in that six to 12 month window, even though they might be three or four years old, you're gonna see them fall out of that chair.

unknown: 15:25

Yeah.

SPEAKER_05: 15:26

That's what they're that you're they're not gonna sit. And then you're going to be running your behavior plan trying to get them back in the chair.

SPEAKER_01: 15:34

That's that's a we love talking about that particular point you just made there. It's like, so this behavior happened. Why did it happen? We're gonna point it back to some sort of diagnostic trait of non-compliance. It had nothing to do with that. You were having a child sit for maybe way too long, and it's it's a tough exp, it's a tough uh it's it's a confusing circumstance, right? You just made the point. You've got a three or four-year-old who's of a certain physical stature and shape where you can reasonably expect them to sit and pay attention, but developmentally they're 12 to 18 months. So that's what you're gonna expect now a a uh motorically capable three to four-year-old who can move and throw and do certain things, but their attention may not reflect that. That's that's a tough gap. That's where the uh you know the behavioral part comes in. And you're lending a much a better understanding of that in the way you describe it, um, and saying these things aren't just behavioral in nature, they're behavioral for us because they seem like noncompliance or whatever the word we're gonna use, but at the same time, this is where this child is at. There's there's just no way around that.

SPEAKER_05: 16:42

Yeah, lack of understanding and lack of of skill. They're just not they're not there yet.

SPEAKER_01: 16:48

I love the phrasing for parents, they only get older and stronger, they only get bigger and stronger. That's uh that's all they do. So we gotta we gotta get that sustained attention going now. We gotta get some semblance of you know uh motoric control so they can sit and pay attention or uh you know follow instructions, collaborate with you to some extent, because they they only get bigger and stronger.

SPEAKER_05: 17:06

They only get yes, yes.

SPEAKER_03: 17:09

So, Amy, question for you. Um, kind of looking at your whole, I guess, career. So you started, you were doing DTT, you were kind of pushing the the boundary with that, moving to PRT, you found that maybe you didn't vibe the best with the PRT, or maybe that had run its course and you wanted to push past that boundary. Um, then you started your own company, and then looking at the hours, you um originally started with more hours and you wanted to push the boundary of can we do less hours? Can we do tutor uh tutorless services? And then now kind of pushing the boundary of moving services more parent directed uh versus therapist directed. Um thoughts on thoughts on that just in general, maybe what what leads you to want to push those boundaries um rather than just kind of fall into place and and how you notice those things and any thoughts there?

SPEAKER_05: 18:00

Um gosh, what got me to this point? Well, I mean, my what got me to this point has a lot to do with COVID. I loved what I was doing, and I like I said, I um the business that I started still exists, my previous business partners are still running it. I was just ready to exit. Um COVID kind of did that. Um I also just had an opportunity to spend more time with my own kids. And um, as any, you know, working professional, you know, with children understands, it's like you're you're always you always feel like you're failing either at work or at home if you're trying to do it all. It's just hard. It's a hard thing to manage. And so I had the opportunity to um focus a little bit more on my kids. And so that's when I exited my my in-home services agency, and um, which is still alive and well and and doing great. That's awesome. And um, yeah, and then it was shortly after that that my husband had um he he actually he's in a different field in software and he sold his business. And so he had been um bugging me for years to take all of this online and do something with it. And I was like, I don't even know what you're talking about. I don't know how to do this. What are you talking about? Like we go into people's homes and work directly with kids and parents, and I don't I don't I don't get how I so anyway, he talked me into it and um he and his um business partner actually are the ones that build the app. And so um I kind of designed the app with how my own brain works and how I kind of tackled early intervention ABA programs, and um, and then they were able to build the app for me. And so that was two years ago. Um so it kind of stumbled into it. I didn't really, I still I loved what I was doing, um, but wanted needed to have a little bit more mind share here at home. But I think that that, you know, and and what I love about Happy Ladders too, from a business perspective is that it scales. I can support, you know, I'm supporting 50 families right now from home. And I could never do that. You know, if I were out working directly with them, I might be able to support five or 10 at a time. And I would be driving all over the place to do that, which is fine, you know, and I think that's and but based on kind of the where I'm meeting these families now, I I really like um the the support that I'm that I'm able to give them. And so so one thing I love, I love that it scales. Um, I think we've done a lot to increase access. We're working with a lot of families that are in rural areas of California that's so important, you know, they can't get ABA services, they can't even get developmental services because they just live too far out of town, they only have one car and you know other parents taking that one to work. Um and so I love that we're able, so you know, there's a lot of um families in Imperial County that are in need of um developmental services and kind of early ABA services. And so we're hoping um, you know, through that process through San Diego Regional Center to get to those families. Our app, I forgot to mention to the app is also available in Spanish. Um and then we have Spanish support available to families too. Yeah. So um, yeah, you know, I think that's that's kind of, you know, my next this is, you know, my my most recent evolution is to try to scale and and help reach as many families as possible. And um, but also understanding for the families that I have whose child does have an autism diagnosis or will get an autism diagnosis, is like, what are we preparing them for? And I'm preparing them for, you know, programs like yours, right? Knowing kind of what the expectations are going to be, what kind of support they're going to have available to them. Um and I am still, I mean, I'm a huge believer in though it might not sound like it, but um, you know, I believe there's a time and a place for 40 hour programs. I believe there's a time and a place for 20 hour programs. I still think that there's a time and a place for discrete trial programs. It's not just, it shouldn't be for everybody. It shouldn't be a blanket recommendation for everybody. And I think that as a field, you know, BCBAs really need to look at how to preserve those services so that the kids that need them the most, you know, these kids that do have profound autism, that those families can access those services because they need them. I mean, they need them for safety reasons.

SPEAKER_03: 22:37

Yep.

SPEAKER_05: 22:37

Um, and you know, I I see families that are going without and and then that's you know, we're on waiting lists and they need something now because they're about to fall apart. Um, you know, and so I think hopefully that's kind of the next step in where our field gets um is understanding um that, you know, this this this journey, this autism ABA journey, it's a journey. And what you might need at one one point might be very different than what you need at another point. And how do we make sure that families can access all those different levels when they need them?

unknown: 23:08

Yeah.

SPEAKER_03: 23:08

Yeah, that's I I hope we will continue to connect um outside of this podcast because I think we can both utilize each other's services to um get get your uh you know happy ladders across. Um it sounds like it would be so useful to a lot of the families that we work with. I think I mentioned off of the um before we got on the stream that, and I mentioned it too, that we've learned as much from parent groups as they've learned from us. Um in the last couple iterations of the parent groups, maybe the last two or three years, one of the things I'm most proud of is we made a Google Drive, uh Google Doc with all sorts of resources. So uh regional center resources, adult resources, community like soccer things. It has all the presentations we have, all the handouts we have, just like a depository of all this information because a lot of the parents would, you know, they get an autism diagnosis and they're like, Oh, your child has autism by. And parents are like, uh okay, like what do I do? Um school resources um is a big one. So I was really proud of that. And it sounds like you know, that's kind of something that Happy Ladders can provide as well. Um we also um put together a presentation. We actually haven't delivered it yet. Uh we got to get back in touch with Matt. Presentation I'm really, really proud of. And again, maybe we can connect in some way, shape, or form with it. Um, but it's roughly about our presentation, and most of it isn't us talking. Um, we actually interviewed two previous clients, uh, the parents of the two previous clients, and they were just talking about their journey, about that kind of what it felt like to get the diagnosis, where they went. Now they've had services for a long time. So now, being that they've been the recipient of services, looking back, what would they advise other parents to do and not do? Um, combines like a lot of okay, and then they're done talking. We talk about regional center, what regional center can offer you, what schools can offer you. Um that presentation we're I'm also pretty proud of. Just again, like like you're talking about, um, giving the parents this empowerment. Um, I mentioned in the in the parent groups too that we used to run a parent group uh on Friday mornings. You were a part of that one, Mike. Um, and it was three newly diagnosed kids, and it was three families. Sometimes there would be a fourth, but three consistent families, and almost every week one of the parents would be having just a breakdown. It would be a different parent like every week, but just something. You know, one of the parents was a single mom, two kids, um barely slept, another parent had like three siblings, like just a breakdown about something. It's like if we can't give these parents resources outside of just ABA and saying, well, ignore your kid when your kid cries at night, even considering you've had one and a half hours of sleep and maximum you can get three, like if we can't give them other resources and supports outside of it, then our services are not going to be effective. So what you're doing, I think, really sets that tone for what we're doing.

SPEAKER_05: 26:07

Yeah. Yeah, that's awesome. Yeah, no, I I I love the idea of um capacity, you know, and I feel like any parent, myself included, has a certain capacity for challenges learning, right? At any given point. And I feel like a lot of our parents who have newly diagnosed children, their capacity is probably at its lowest.

SPEAKER_03: 26:36

Yep.

SPEAKER_05: 26:37

Right. Um, in terms of their anxiety, their stress, their worry, um, their relationships.

SPEAKER_03: 26:44

Yep. Guilt maybe.

SPEAKER_05: 26:46

Guilt oftentimes they have an infant in the home too. There might be a younger sibling that's really keeping them up at night too. So they're just not even getting enough sleep. They're probably not eating well. They're all all the things. Yeah. Right. So their capacity is just, you know, at its lowest. And that's, you know, and I I do find that a lot through our onboarding appointments with parents is that, you know, they do get on the phone and I can tell they're on the verge of tears. And it's like, okay, what can I give you? What small win can we get here so that you feel like you've done something? You know, even if you can't get the dishwasher unloaded because you might not even be able to get that. What small win can we get, you know, so that you feel like, okay, we're on the right track. Um, and that may be, you know, implementing a simple activity for two minutes a day. Great. That that's what you can do. That's what you can do. But that's where they're starting. And so I think, you know, that that idea of capacity. And then what we see over time is that their capacity grows. They might just start with one activity. Um, we generally have four recommended at any any given time. I say, start with one, just do one, you know. But over time they start to add more and they are running a more robust program.

SPEAKER_03: 27:57

So you're using ABA principles of shaping with the parents. Huh. Look at that. It's amazing how how we can utilize these things.

SPEAKER_05: 28:06

Um yes, lots of ABA with with parents. Yeah. Well, yeah.

SPEAKER_01: 28:11

I love the contrast you just made too, because I think it's very important to say what you said. There is a time and a place for more intensive 40-hour programs. Not everybody should have it. And then on the other end, you're saying it might be as simple as two minutes a day of something that you're doing that you're building on. And it's everywhere in between. And I think that that uh somewhere along the line we may have lost sight of that, and somewhere the fiscal health you know takes over, and 40 hours a week for every client sounds very attractive and it's very predictable, and you can run your numbers and pay your people. Those are all good things. And then uh, I think to your greater point, Amy, not everybody's well suited for that. Even if they need it, the family may not have the resources to access it or the wherewithal to access it. And it could be as simple as two minutes today, and then next week we're gonna add a few more minutes, and then we're gonna and it's incremental. That's that's beautifully stated.

SPEAKER_03: 29:07

There probably still is a place for 40 hours, although I'm pretty jaded to that over my career. I would I don't know, this is not empirically validated at all, but I would say probably less than 10% of the clients that are recommended 40 hours actually need the 40 hour services.

SPEAKER_05: 29:28

Yeah, I mean, they're probably getting closer to 2530, right? Anyway, right, that would be pretty good. Yeah, um, yeah, but you probably have to shoot for 40 in order to hit 2530.

SPEAKER_03: 29:39

Well, I okay, I was coming from a different thing. I was saying that I think a lot of companies vastly overrecomend services for their own needs, not necessarily the client needs. Um, and this kind of goes back to the other question I was gonna ask because I think we vibe a lot on the the lower hours. Um, most of I don't think we've done more than. A 12 hour week program in a long time. And again, not saying that that that not saying that there's no client ever that needs more than 12 hours a week. But you kind of um push the boundaries with the tutor list services and you said like four to six hours. Um so can you speak to maybe where that came about? Because that certainly wasn't the industry standard when you did it, why you did it?

SPEAKER_05: 30:25

Um so yeah, so that was back in like 2007. Wow. Um we pitched it. We pitched the idea to our local regional center that we had worked with. So they trusted us. I I actually pitched happy ladders to the same group of people like 15 years later, and I don't know that it would have got approved because it was also a crazy idea. Hey, let's do all this hairline stuff through an app, you know, and they're like, okay, which I don't, you know, I we got very lucky, so thank God for you know long-standing relationships.

SPEAKER_03: 30:56

Absolutely.

SPEAKER_05: 30:57

But yeah, I what motivated us to do.

SPEAKER_03: 31:02

Where did it even come from, though? Because fiscally for your company it wouldn't be the best thing. So how did you come about it?

SPEAKER_05: 31:08

We we we pushed pretty hard on a lot of that pivotal response research. Um, and I think that that helped support our thought that four to six hours might be enough. Um and I think you know, we were we were hugely, I was hugely motivated to no longer employ tutors.

SPEAKER_03: 31:33

Okay, that was your motive. Okay.

SPEAKER_05: 31:34

Yeah, selfishly. Um because at this point, myself and my my two business partners had you know started as uh tutors, worked as consultants, supervisors, and we were directors at that point, you know, at a a large agency. And um every day was the same thing. You know, it was often parents calling in mad because their session was empty again, because they lost their great tutor because we promoted the their, you know, the one tutor that their child loved. And it's it's you know, it's it's funny getting on LinkedIn and reading these stories where I'm like, gosh, this stuff has been happening for 20 years. Right, right. It really hasn't changed. It's just it's just happening on a larger scale. And we're kind of, you know, we're we're repeating a lot of the same problems that we just haven't been able to solve for yet. We have to look at some other ideas. And once it's still saying, like, I I love the RBT role. I think there's, you know, there is a time and a place for programs that are, you know, larger than 12 hours a week. Um, but if we don't have to do that, we don't need to do that, you know, and and parents can be happier, kids can have more fun. Um, one thing that we haven't even really touched on is the job is so much more enjoyable for employees, for BCBAs, for RBTs, you know, when we do look at, you know, uh a less intensive, more play-based approach, it's everyone, you know, so then less turnover, yeah, it just solves for a lot of that.

SPEAKER_03: 33:11

You made that observation, I think, yesterday when we were having the last meeting, our last company meeting, you uh the observation of our cancellations versus our previous company's cancellations.

SPEAKER_01: 33:20

Oh, yeah, I think that probably has a lot to do with it.

SPEAKER_03: 33:23

And how it's so less frequently canceled at our current company with far less hours recommended. And it could just be a pure metrics thing, it could just be opportunities. But I think even if you look at the percentages of sessions cancelled, it's way less.

SPEAKER_01: 33:36

Well, and I think there's a great correlation with that that maybe we can explore quickly, but the idea that um our RBT gets to see us a lot, um, we are huge on parent participation, so even if they're not directly uh hands-on in the session, we're doing the session where it's visible and observable and they can hear it or and otherwise be a part of it somehow in terms of observation. Um and I I think that there's a lot to say that if we're not canceling and they're always part of that, then I think it cultivates uh you know a greater continuity. But we should you know we shall see. I think uh one of our objectives has been redefining the RBT role because we do think that um it's especially here in California, it's really difficult given the range of pay, uh given uh you know the idea that you could make as much money, if not more, and have more consistency in your hours if you go work fast food. Uh I don't think that many young professionals went to get a bachelor's degree to work at Chick-fil-A, but if they're paying you better than your RBT with your psych degree, uh you might go do that. So uh yeah, I mean I I think a lot of what's happening, not just in terms of the lack of support and the training, but our big concern over the past few years was the RBT turnover. You really couldn't build any continuity because it was two, three weeks and before somebody quit, or uh you were waiting for staffing and we would have a huge training class come in, but 60% of them would drop out during training. So it was like, well, good riddance, because I'm glad you did it now instead of starting a case and doing it then. Uh but yeah, it's it's just become such a difficult thing to manage. Uh and you're right, Amy, a lot of the same problems that that you left behind are still happening. Um, and it is totally our objective to try and change that because it is, I think it's important to have those young professionals who, you know, did a psych degree, for example, to be able to see that they can do something with it and that they can actually grow in the field and and and learn new things. And I mean, the idea that somebody could become a career RBT, that's impossible right now. We haven't made that provision yet. It would probably be a very useful um tenant for the field to have somebody like a like a registered nurse who's very experienced and can train other nurses. Uh but right now the assumption is the RBT becomes the big bad BCBA. So somehow people are losing that continuity no matter what, uh, with that RBT role.

SPEAKER_05: 36:01

Yeah, yeah. I really love that mid-level role. And I don't know how common that is um in in your world, but we we use the mid-levels. Um and I I just I really like because the bachelor's level, yeah, um, and or or higher. And so there was a commitment to the field. Um and yeah, so we just saw you know less less turnover too. Um and the the reimbursement rate was was better.

SPEAKER_03: 36:31

So we don't really use a mid-level, but all of our lower level would be mid-level equivalent, I think. Oh so because like the mid-level at one point was like the BC ABA, um that level, but the the way insurance typically works, at least with us, is you either have your BCBA or you don't, you can either build 97155 or 97153. Yeah, um, so there isn't really like um uh a lot of value per se in the the mid-level that we've seen. And please, please um correct if we're wrong, uh or if you see it differently, excuse me. Um unless maybe you're having a whole lot of inexperienced RBTs, then having a more experienced RBT to lead them. Um, but we just typically have the services provided either directly by the BCBA or by a mid-level equivalent.

SPEAKER_05: 37:23

Yeah. Yeah, it might be it might be different. Um, like I said, we worked with the Cataly provider network.

SPEAKER_01: 37:30

Right, sure. Yeah, they do well with that if I understand correctly. And regional center makes good provisions for that. I guess that second tier, if you will.

SPEAKER_05: 37:37

Um yeah, maybe we we built a completely different service code with the regional center, so I don't even know what those what those uh like ABA billing codes are or or rates anymore.

SPEAKER_01: 37:49

So I know exactly here in San Diego, having done early start for a little while, um, where your program is gonna come in very uh be very useful because we do have these outlying areas here. Um you you mentioned uh Imperial Valley, we've got um so like the Campos and Hakumba, Hamul. A lot, I think there's 50 plus kids uh monthly, I would say, from estimates that I've heard, um, who go without who have a referral and a need for programming, but it's gonna be inaccessible uh and people can't get out to it. So I think there's a great need that you're gonna be able to fill here pretty quickly and and uh we're excited for you.

SPEAKER_05: 38:29

I hope so. I hope so. Well, and I would love to continue working with you guys and talking to you and just on, you know, looking for opportunities to to work together too. And you mentioned your training. I would love to look at that and possibly put that on the app if you feel like it'd be helpful for parents, um, especially parents that are coming, you know, that are in your area.

SPEAKER_03: 38:47

Yeah, no. Absolutely. We definitely look forward to uh to collaborating. And I I really it's very refreshing to talk to somebody who's saying, like, oh, we want tutorless services, we want less hours. Um that's that's something we've fought for for a while. And it's nice. There are certainly people out there. It doesn't, it seems hard to find them because everybody else that we not everybody else, but a lot of people that we talk to is always justifying the this is why we can do more hours and more hours. So thank you so much. It's so refreshing. Um, even on the parent side, I remember at the previous company, um, we very rarely got complaints. The only complaints we would get would be on the front end on our service hour recommendations. They they'd hear that their friend's kid got 40 hours at another service, so they wanted 40 hours, not even knowing anything about what that looked like, what that consisted of. Um, so they would come in literally before we even did the assessment. Will you give my kid 40 hours? I don't know. We haven't done an assessment. Okay, but after you do the assessment, will you give my kid 40 hours? And eventually it'd be like, we'll give you eight hours direct. If you want more hours, we'll give them to you as parent training. Like that's we'll we'll write you a nice parent, we'll see you four hours a day with parent training if you want. All of a sudden they're like, uh no, I don't know if we want that anymore.

SPEAKER_05: 40:01

An honorary degree. Yeah, absolutely.

SPEAKER_01: 40:04

Well, and that's a that's an interesting point that we keep, I think, making indirectly uh with something like your program, uh Amy, or your app, you know, people are are sort of following a guide or a curriculum for a certain amount of time, but that potentiates that empowers them to then employ or implement those things ongoing toward that notion of a 40 hour. So instead of this becoming this isolated treatment, which a lot of times um you know site-based services run the risk of, right? The the treatment happens here, the parents not watching, and then we go back to that problem with generalization. Is it gonna happen? Is anybody gonna do anything outside of the clinic outside of these services? But what your app does is it empowers people to always consider yeah, we have these activities that we do, and then I'm sure those carry over. We're always thinking about how we can implement these things. And I think that's a nice way to sort of bridge that that gap. We might only give you eight, twelve hours of service, you know, in our case, directly a week. And then, yes, you'd like to make this point, Dan. You spend the rest of that time with your child. And often we don't do a very good job of telling you what you can do with your child during the rest of that time. I think that's where your um app comes in very nicely uh and could collaborate with programming ongoing to tell people, yeah, this is the things that these are the things that you do day to day. This isn't this stop everything, set up the table and chair intervention. This is literally moment-to-moment things, and that's what parenting is, right? Exactly, exactly. It's it's it's now uh right, it's a lifestyle, it's not this just a concentrated intervention, it's the generality of what did I learn in that isolated moment in this intervention, this therapeutic setting? And then how does that apply the rest of the time in a way that's naturalistic, open-ended, uh, you know, provides for uh autonomy and agency and all those things that um if we get overly authoritarian in our style, we we run the risk of of stifling.

SPEAKER_03: 42:02

So we've talked a lot about the app and kind of around it. Um can you talk specifically about where it can be found, maybe the price point, um, the specific features, maybe what it looks like. Um, so parents listening can know all about the app, where to find it, what it might be useful for specifically, the features. Open the open floor for you to uh talk about this app. Uh sure.

SPEAKER_05: 42:26

Yeah, well I'll I'll I'll keep that piece short. Um they can go to happy ladders.com to read more about it. I believe there's a demo on the website. Um there's also a a blog on the website that I started during COVID. Um that that talks a lot about kind of the what we just talked about, you know, our our experience, my experience and philosophy um around therapy. And um currently families can only access happy ladders through the regional center system. Um so if they are, if their child is a regional center client, they can um approach their service coordinator um about happy ladders and getting access to it. And and it's it's built like a monthly um subscription.

SPEAKER_03: 43:16

So regional center covers that or they pay for that after it's approved.

SPEAKER_05: 43:21

The regional center covers that, yeah. So they they write the authorization for you know however many months for the family to have access. Um sometimes, you know, with families uh they will come into the regional center system kind of late. And so they might only have like two months eligibility with regional center services before their child ages out. And here in Sacramento, they age out at age three. Um and um and they it depending on whether or not they they stay, so and that's kind of a complicated process. But with Happy Ladders, um, when service coordinators refer families to us, the family can get access that same day. So they can start programming that night and start, you know, running some of these play-based activities, you know, at dinner time or bedtime or bathtime. Um what do you think?

SPEAKER_03: 44:16

What does that look like? Is there like a like a list of activities? Okay, you've just started with us, try these activities, report back. Is it like where are you having problems? And then it develops a program based on that. What does that look like?

SPEAKER_05: 44:27

So parents, they sign up and um they there's a few videos they they watch, a few training videos that are really short. Um, and then they get access to the assessments. And so we have um four assessments. We have uh community communication, play, self-help, and what we call community and coping. And these are all skills, these are we're looking at developmental skills across the board. So within those four domains, we've got um your receptive language, your expressive language, um, fine and gross motor skills, socialization. Pretty much everything's covered, um, up to 36 months old. So in our community and coping is really like a lot of those like community behaviors, um, transitions, things like that, those early, early skills that kids need. Um and so parents go in and they take these four assessments, they check the things their kids can do, anything that they are not yet doing, they leave blank. And then from there, the app creates a personalized um plan for their child that then recommends activities to target the the next skill, the first skill that they left unchecked in each of those four categories. Um there's simple activities that the you know parents can listen to the instructions, read the instructions, whichever they prefer. There's a simple skill associated with each activity. And so they run that that activity. They're usually they're usually social games. Um we have a lot of play skills um too. So a lot of a lot of stuff that you guys run through your programs, right? Um a lot of cause and effect. We do a lot with books so that we can get to a point where kids will kind of sit and look at books, but we got to start at like a really small level sometimes, just getting them to sit and attend to the book for five seconds. And so we've got, you know, that may be where the activity starts. Um, so as kids um master each skill, then parents say, okay, this activity is mastered, they mark as mastered, and then the app feeds them the next activity for that particular area. And they just keep moving through. So there's some simple data that they can take within the app. Um they can request support in any time, they can post questions, they can schedule office hours. Um, there's quite a few different ways that they can get support. And then, like I said, we have a few other um resource library and then also the community within there. So those that's all available, um, like I said, to regional center families whose service coordinator puts in an authorization. Um, for any families that or even families that are listening that would like access, we always take scholarship families. And so um we don't have a private pay set up at this point, but for families that do reach out to us, um, we do offer scholarships and give them access to the app. And as long as they're using it, which we monitor um on the back end, as long as they're using it, they can have access to it for however long they need. Wow, right. Yeah, so we have a couple families. We have a um a family out where are they? Are they in Illinois? Oh wow. Um this particular parent's been with us for almost two years, and she's just working by herself. Her son's been on a waiting list for ABA this whole time. Oh wow. But she she has almost mastered our whole curriculum with him. And so to me, I'm like, imagine had she not had that, how little progress he might have made over the last almost two years that they've been on a waiting list.

SPEAKER_01: 48:09

So your regional center will be specific to California, and then you're saying you're reaching out to people elsewhere uh from this scholarship perspective. When we first started talking, uh for some reason you made it immediately made me think Nebraska. I always think of Nebraska as as the state where there's there there must be, and I'm sure there's other states in the Midwest, but Nebraska where there must be a lot of people in remote areas who, you know, as a service provider, we're probably very difficult to get to them. But an app like yours would would make that uh very accessible. About Alaska. What? About Alaska. We've got our uh we've got our colleague uh our our our uh our friend Jennifer over in Kentucky. Uh she might have a lot of interest in this.

SPEAKER_05: 48:54

Yeah, yeah. You know, and the other um and we've we've talked about trying to get into other states once we you know continue to expand throughout California, but um, you know, and not all states are very tech friendly, especially at the state level. You know, so um so that does take a little bit. Not everybody loves this idea of an app or thinks that it's even possible, you know, for it to be effective. And um that definitely happens through these state agencies, that there's you know, people that are just more resistant. So it takes a little bit of work, kind of um there are some states that are a little bit more friendly um to tech solutions at this point. But you know, the other avenue that I really thought would be interesting to look at is, you know, within all of these ABA companies across the country that have waiting lists, you know, if you're trying to give some support and give some momentum to families that are waiting. And I know in California we're not supposed to have waiting lists. Um but the reality is that they're there. They're there.

SPEAKER_01: 49:59

Yep.

SPEAKER_05: 50:00

So um, you know, but how can some of these ABA agencies give, you know, their younger clients something, give these families something to do while they wait? Because I think that, you know, for as a parent, just having something that you can hold on to and do with your time and your energy so you're not just sitting and waiting. Um, you know, that that would make me crazy if I were a parent.

SPEAKER_01: 50:24

So you're good about inviting people to the parent training groups as they wait. I like that.

SPEAKER_03: 50:29

Absolutely.

SPEAKER_01: 50:30

Yeah, it's already happening, we're already giving out information. Just join and listen and you're waiting. Yeah, that's a great idea. I I I hope you're able to do that. That I think that's a really good idea, and maybe that's where we'll connect um off the microphone to see if maybe we can help with that. That's a that's a fantastic idea.

SPEAKER_05: 50:47

I would love that. I think that'd be a really cool, cool pilot to run and see. And I would love, you know, I selfishly, I would love to see how those parents look once they do start a program. Yeah, right. It's like what how how did how do they look compared to parents that that didn't have that jump start?

SPEAKER_01: 51:06

Yeah. Yep. Well, we've covered a lot of ground. Anything we didn't cover?

SPEAKER_03: 51:13

Anything uh before we we wrap up that you'd like to talk about happy ladder is there anything anything in general that you'd like to bring up, Amy?

SPEAKER_05: 51:21

I can't think of anything. I just thank you so much for this platform. And it's it's just it's it's really fun to talk with um like-minded professionals. Um like you said, we're a I we feel few and far between. I don't think we are.

SPEAKER_01: 51:39

No. No, we just gotta get out there and talk to each other more. And I think so. We thank you for your time and for putting out your app and and uh for making yourself accessible.

SPEAKER_03: 51:48

We will continue to collaborate for sure.

SPEAKER_05: 51:50

Yes, I look forward to that.

SPEAKER_01: 51:52

Wow. So I didn't prepare my little uh my little outro. No, I usually prepare it. What am I gonna say, Dan? Help me out.

SPEAKER_03: 51:59

Um, well, uh always involve parents. Always involve parents. Um well Amy's always pushed the boundaries, so you can always push the boundaries or look to improve. Less is more, less is often more and always analyze responsibly. Cheers.

SPEAKER_05: 52:15

Beautiful. Thanks, guys. Thank you.

SPEAKER_02: 52:17

Always analyze responsibly.

SPEAKER_00: 52:20

ABA on fat 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.