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Supporting Parents in ABA Therapy · ABA Business Leaders

• speaker-0: Those homes are not clinics, they're their real. homes. I know a lot of times we would get some discussions from texts and say, Oh, every time we show up, mom like disappears and goes and takes a nap. Why do you think she's taking a nap? I had a parent who was really averse when her child hummed consultants like, well, that's just part of who this kid is. They're gonna hum us a stem. And then the parent was like, but I don't like it. Fast forward a little time later, and I got there to the session and the mom was like in tears. And she said, I slapped my kid, like I could not handle the humming anymore. And she was like, I feel horrible. I'm a terrible mom. Like client is the child, the learner, but it's also the family, the parents, the caregivers, we have to give them the tools. Welcome to ABA Business Leaders podcast brought to you by Three Five Squared. I'm April. So today we have Zandra from Beauty and Behavior. I came across her work on social media and there some of her posts or reels or whatever they came through and I was like, I connected with it so much, right? And so it really definitely caught my attention. And so then I went over to her website and I checked her out and I'm just like reading through your stuff on your website. speaker-1: I'm Stephen. speaker-0: And immediately I said, I have to reach out to her. I need to have a conversation with her and hopefully she'll come on the podcast to chat about all of the things. So Zandro, really stood out to me is your focus on helping professionals support families in a way that creates lasting change. You talk about not sacrificing their values or their sanity. And that really aligns with a lot of the conversations that we have here to support business owners and business leaders. I think that that we have a mission that we've been wanting to get to that we haven't been able to put as much time into. that is then how to help those business leaders to support the families in a better way. Zandra? We're so excited to have you today. So before we jump into our topics, I would love to hear a little bit about your work and what led you into this work with parents and just kind of like the why behind the cause. speaker-2: Yeah, thank you both for having me here. ⁓ So hello everybody, all the listeners. My name is Zandra. I am a BCBA. I've been in the ABA space and the office and services space specifically for over 12 years now. I've been everywhere really in the homes. I've been in the clinics, I've been in the schools. I've jumped from company to company over the years due to my own experiences with burnout and we'll get a little bit into that. ⁓ Beauty and behavior was something that I started in 2020. I was a BC ABA at the time. And at that point in my career, I was seeing a lot of challenges with retention. I saw some good colleagues leave due to burnout, due to just the many challenges that we all face being in this space. So Beauty and Behavior started out as a blog really just to put the word out there. My intention behind it was to share what ABA is, what it is that we do as providers in this space. ⁓ My main intention really was to inform people outside of the field and say like, hey, ⁓ this is a really cool space to be in. ⁓ Why don't you come join us? I was really honest about my experiences as far as challenges that we face. ⁓ I didn't want to shy away from that. I really wanted to share the good, the bad, and the ugly about our field. I didn't want to shy away from talking about the challenges, but I definitely also wanted to highlight how what we do to support the families and the individuals that come to ADA for their needs. And so I wanted to bring to the table really the beauty and understanding what behavior is and what can come out of that. So that is how being a behavior was born. ⁓ That led me to really creating a following of providers. Now, my intention, right, was to reach people outside of the field, but the more I grew and grew, my presence grew. providers found me so our BTs BCBAs teachers sometimes ⁓ and Same thing as you April like a lot of people started to reach out and say hey like your work your words are really resonating with me like I'm experiencing this too and It really stuck to a lot of people and so that came the increase right? Hey, are you consulting? Do you provide remote supervision? I didn't think about it at that time my I had no plan really to take beauty and behavior and form it into a business, but really my audience led me there, led me to that point. So I did start offering consultations. I did start offering remote supervision. And this was simultaneous to me building my career as a BCBA. So I went through the whole like BT. ⁓ They didn't have our BT at the time. So I was a BT up until the point I was a BCBA, jumped into BCBA. ⁓ And so full-time employment and then human behavior after hours. speaker-0: That is, you there are a couple of things here that I wanted to bring up because I could see the connection between them. And so, you know, you have a lot of content talking about burnout, right? And part of that is a lot of what we talk about here too, like being able to assess like, what's essentially filling your bucket and what's draining your bucket, right? And building your dream job and knowing what you enjoy doing and what you cannot stand to do. Now, of course, we're adults. who own businesses. And so sometimes we're going to have to do those things that we don't care to do because that's just life. But those aside, it's really nice to know. OK, so we talk about this, but it's also nice to know that, hey, here's an actual real life version of what this could look like. And so because a lot of those ⁓ things that drain your bucket are like dealing with high caseloads, high turnover, insurance. And in the high caseload itself, we could come up with like 20, 30 things, right? Like there's just a lot of barriers there, right? And then also too, I think there's something to the mindset of, okay, we're the expert coming in, essentially teaching you how to do, how to parent your child, right? And so I guess it kind of depends to either it's clinic-based and there is a big, you know, I've seen some clinics do it well where they bring parents in for parent training like once a week and stuff like that. and they'll be flexible to go into the home and do some generalization and stuff like that. for the most part, if it's in clinic, it's like, it's so separated. This is what's happening at clinic and this is what's happening at home. And a lot of times they don't even see the same behaviors. In home, sometimes as VCVAs, we come in a little forward, a little too in charge and just take over and tell families what to do. And so there's gotta be this medium here. speaker-1: And so Xandra, your model is like parent led only or do you work with the kids or like how does it how does it work? speaker-2: Yeah, so when I started working in that model through that company, it's case by case, right? We have a vendor out here in California who I think is really leading the charge with the current lead model. I don't really see it across other funders, sometimes maybe, but really just one funder. And case by case, we'll take a look at, is this a situation in which it would be recommended for me to just sit down with parent, mom, dad, or caregiver? ⁓ involved to support them with ⁓ what to do. They come to me with ⁓ what challenges they're facing and we talk it through together or is this a situation in which they would benefit more, right, with me being in the home or being there in the home with a child to provide modeling for those strategies. Some of the families were okay with, some success, right, with talking it through, ⁓ going about their day and then reporting back like, hey, I really just focus on reinforcing my child throughout the day for the things that I wanted to see more of. And that was magic. Thank you for that. So it really depends, I think, on the family. And now within beauty and behavior, now that I'm no longer tied to an employer through my business, I do more of just that coaching approach of where it's me and parent. ⁓ I do everything remotely at this time. I do want to offer in the future some of that in-person support. ⁓ I am a new mom, a stay at home mom. So not a season, but hopefully a season in the future. speaker-1: Right. And why do you think that more companies don't do social skills groups? Because, you know, when I am talking to a clinic, I'm like, have to add social skills, right? There's so many reasons why you would want to do that. No, like it's more profitable, right? Like if you're just talking money, it is more profitable. And then ⁓ you can you can take this huge wait list that you have in the after school time. Right. And you could create social skills groups. And it's great for the kids. because if you can work with a 25 year old, bubbly, IRBT, right? Okay. But if you can't generalize these skills to peers, right? Like what are we doing? Right? And social skills can really help with that model. And then you can have those group parent trainings, right? And so ⁓ do you have any guess as to why clinics kind of shy away from social skills? speaker-2: working at the agency at the time when my focus was social skills groups, I did see challenges with quiet matching. Quiet matching, think, is one of the challenges there with ensuring that the learners skill sets were good matches to work together within a group. It's also, ⁓ that was the only experience that I've seen really with how a agency runs social skills groups. I'm sure other agencies might have different things to say about it, but because it was speaker-1: Right. speaker-2: insurance-funded. of the kids were on different ⁓ points. They were all on different points in time within their treatment authorization. speaker-0: Yeah, that was, yeah, that was our that was really when we had a social skills group. That was our biggest barrier was to be able to group the appropriate like the kids together appropriately. Right. Because you can't you know, you have to be you have to be working on at least similar or coordinating skill sets ⁓ or it's just kind of one on one within a group. You know, and then you need more and you more therapists and like more tech to get that going. Right. Because if you don't have kids. I mean, you can work on parallel play or something like that, right? But I think it does get complicated beyond that. speaker-2: Yeah, yeah, absolutely. With the billing and the scheduling and everything. ⁓ Those were definitely challenges that we saw come up within the work group to kind of just brainstorm ways that we could make it an easier process. I didn't see the turnout of that, unfortunately, but I know that there are agencies out there who are trying to make it work. ⁓ I'm peer certified. It's a social skills group, focus certification out of UCLA. watching their model, I was always interested to look further into it actually about how, I guess, how's the structure of the funding for this because that's something that we weren't able to do seamlessly in the agency that I was working out of, right? Because watching peers and someone within UCLA probably could support with more information about this, but learning through their certification, ⁓ I saw that each of the kids, they all have within a group, a start date and an end date together. So it might've been like a, I don't know, three month program. It's the same years within that group from beginning to end. But then within our agency, again, each of the kids had different, they're at different points in their authorization period. So we might have one group with eight kids in there. And in January, we have two kids that started together. We have maybe others that move out of the group or graduate out of the group because they've completed all their goals and then they... switch them out with newer ones, it was a challenge. they had new peers every so maybe every two weeks. speaker-0: Yeah, there is a lot of that. That's a lot of challenge to coordinate that. I think sometimes it is like looking at, especially when you're with the insurance model, kind of looking at balancing those challenges and making it worth your while. speaker-2: Again, tying it back to the parent piece, was a social skills group model, but within our social skills group caseload, we made sure to have that parent involvement piece there. Because obviously, are not involved, at least within our agency, we didn't have parents involved in the social skills groups. So we made sure to connect with the parents outside of groups and say, okay, this is what your child is working on. This is my homework assignment for you to ensure that they get opportunities outside of groups to practice these skills. with siblings or whatever other opportunities that you can support with them or support them with having. speaker-0: So I've always loved working with parents, like even from the very beginning when I was in the field pretty young myself, because I feel like I had babysat for many years. Like I started babysitting when I was really young and had babysat for many years. And I had kind of like a view into people's homes and kind of already had like a sense of family dynamics look like maybe that's why, I don't know. But I always felt like I really liked working with parents. I noticed, I said often like, ⁓ well, I know I'm not a parent. However, this is kind of what I feel like I would want, if I were a parent. And then when I became a parent, my approach shifted even more, right? And I feel like I always saw parents as part of the process and that they needed to be part of the team and have a say in what happened in their home. think that a lot of providers or BCBAs really, I shouldn't say a lot, but I think one of the issues that we see from time to time is that, you know, having a hard time using too much jargon or coming in and just saying, okay, this is how we're going to do it. Here's the problem. You know, listing out all the, all the skill sets that your child needs to work on, all the weaknesses, all the deficits, all the, all the ways that, that, that your child needs. fixing, right? Even if we're not trying to come across that way as a parent, it could very much feel that way. Even if as a parent we're like, yes, please come help, please help. It still is that balance, right? And so, you know, I'd like to talk about, ⁓ you know, meeting parents where they are and ⁓ what that actually looks like in real life. And, you know, how do you adjust when a parent might, you know, how do you know, like, if a parent feels overwhelmed or if they're not engaging and how do you adjust for that? speaker-2: I you spoke to a lot of the challenges that we see as providers. mean, me myself, mentioned always appreciating this part of the job being a VCBA, supporting the parents. I can't say that I shared that experience myself. And I know that other clinicians might feel the same where they parent training or parent education or caregiver support, however you want to it, is maybe one of their least favorite things about the job. And that was me for quite some time. I dreaded parent training. It was something that I didn't want to do when I was learning how to be a supervisor in my early career. I remember within my first year on the job as a supervisor, now then, or then having the responsibility of leading parent trainings myself, I would sweat buckets for hours beforehand because I was in my head all the time about, how am I even going to be helpful whenever I see this parent? I want to ask questions and they always say they're good. And then my company at the time had this expectation to have, to make sure that our meetings with parents ran for at least two hours at a time. So then I am left there, know, twiddling my thumbs, thinking of things to talk about. And so it wasn't, it wasn't a very reinforcing time for me, you know, it was, and I think that for a lot of providers, it is that skill gap, skill gap, right? It's like, okay, like how am I, how, do I sit here and make sure that I am providing value to this parent? because I want to make use of this time as much as they do. For a lot of them, they are taking time out of their work day or their way out of their day from apart from their other responsibilities. So we need to make sure that we make it worthwhile. I don't want it to be a thing where, and I know a lot of families have expressed this in the past too, providers expressed this in the past too, that they don't want it to be an experience where we just sit there and we check it off the list because it's something that we need to document as something that we did. So to provide that value, we need to really assess, right? And make sure that, okay, first off, are you, why are we here? Right? I want to make sure that I understand your motivations for being involved in treatment. Like we want to make sure if you are going to be involved in your child's care, that first off, you know what the barriers are to your child's learning. We want to make sure that you have, we want to know what your concerns are. I think conversations like that are often missed. between provider and the family. Just coming from my experience with my field work trainees and having Casey's path down onto me from other clinicians, ⁓ I would review treatment plan after treatment plan and talking with clinician after clinician sharing with me, ⁓ parent never signed off on this. They didn't know that this was a goal. And I think that's where we need to really sit back and think about, If they don't have any awareness of what we're working on, that's really where we need to start, right? They need to be part of that process where we sit down together and we say, hey, we did this assessment. These are the goals that I'm thinking about. I want to make sure they're in alignment with what you're thinking, ⁓ what your concerns are for your child. I want to make sure that they're feasible for us to work on together as a team, because it's not just going to be me and my BT or my RBT or my mid-level supervisor, right, who's going to support every... who are going to be supporting your child, building these skills, it's also going to be you. speaker-0: Yeah. speaker-1: Has to be, right? speaker-2: And I think that's something else that's often left out of the conversation, right? Because parents don't often have that expectation of, I'm a part of this. Wow. Like I thought that I was going to hand off my child, you provide the services and that's good. And everything will be okay. And I think at least when I was growing up in the field, that's a lot of what I saw as a DT, that lack of parent involvement and understanding of what we were really working on. Every now and then I'll have a parent. jump into session and say, hey, what are you doing? haven't had, BCBA hasn't explained this to me. So I want to know what you're doing. How is this going to be supporting my child? And I think we get a lot more of those conversations when the focus is the parents within the current blood model. speaker-1: April and I are so honored to have Margin Keepers sponsor this podcast. speaker-0: Running an ABA business comes with its share of challenges. Managing clients, staff, insurance, the list goes on. speaker-1: One thing you shouldn't add to your stress, bookkeeping. That's where Margin Keepers comes in. speaker-0: They're specialists in ABA businesses, which means they understand exactly what we need. speaker-1: With margin keepers handling your finances, you can focus on what really matters, your clients and your practices growth. speaker-0: They're more than just bookkeepers, they're lifesavers in the financial world of ABA. speaker-1: So for peace of mind and expert financial management. speaker-0: Turn to margin keepers. It's a decision that will lift the weight off of your shoulders. speaker-1: Check out Margin Keepers at www.marginkeepers.com and see how they can help your business thrive. speaker-0: Absolutely. that's one reason like this is something that I really tried to do within our company because, ⁓ you know, I felt comfortable with parents and most of my staff did not. I think they would all agree right now. speaker-1: Also, sorry to interrupt, but there's some of that, almost like you're the enemy, right? It's like, if only the parent would just follow my direction, then everything would be fine, right? I don't know. speaker-0: Yeah, but there's definitely disconnect. I think that's, you I don't know, I tried to train my staff by modeling, right. And but then the more that I was pulling out and becoming more of like the owner behind the desk more so than actually, you know, in the first few years, like I was in sessions all the time and training and modeling everything. And I feel like I was really at the point where I had to turn over the intake meeting to my staff was like a really big pivotal moment. And I even realized within myself, I don't know exactly how to train this. And so that was one of the really things that I was really excited about about seeing or ⁓ that you're doing this, that you're helping to train, know, BCPS how to do this, because during those onboarding. intake meetings of parents. I had these, didn't just go through the paperwork and check things, right? Like I had like real conversations with them as far as what this is going to look like for them and what they should be seeing from our staff. if they're not, know, things that they're seeing or not seeing from our staff, I wanted to know, right? Like that, that before they make any program changes, like the BCBA should be explaining to them why, if they have any questions, those questions should be answered. They have a right to say to agree or not agree to goals that we put in the treatment plan, right? ⁓ You know, and, and they are not, they don't have to stay away, right? Cause that was a big thing that I think happens a lot is the parent, like you're talking about, like against the parent, like the bad talk of the parent is, they get in the way every time mom comes in, ex behavior happens, you know, Right, right. were, you know, and that's, have a point later on down in my notes, but I'll just go ahead and address it now. Like people's homes are not clinics. They're their real homes and they have other children. They have pets, they have jobs, they have housekeeping responsibilities. They have their own self to take care of. Um, I know a lot of times we would get some discussions from texts and say, Oh, every time we show up, mom like disappears and goes and takes a nap. Why do you think she's taking a nap? Right. You know, no, we did have some policies that were there had to be an awake alerts. you know, individual, you know, grown up there all the time. But, you know, sometimes like parents also, especially if their child is, you know, high needs, like their needs of the parent too. And then I like what you said about asking the parent what's important to them. I had one of my, years and years and years ago when I was a tech, I had a parent who was really averse when her child hummed. And the BCBA on our case, I don't even think they're called BCBAs at that time, like the consultants back in the 90s consulted on the case. I was like, well, that's just part of who this kid is. like, they're going to hum. That's a stem and blah, blah, blah, blah, blah. Right. And then the parent was like, but I don't like it. And in the BCBA is like, well, that's just not something that we can really work on. And then, I don't know, fast forward a little time later and I got there to the session and the mom was like in tears and she said, I slapped my kid. She was like, I could not handle the humming anymore. And I slapped him and she was like, I feel horrible. I'm a terrible mom. Like this is all that I, you know, so it's like little, think about that quite often. And I thought about over the years and especially as it became apparent, you know, there is there, you know, our client is the act as the child, the learner, but it's also the family, the parents, the caregivers, we have to give them the tools and we have to listen to them to try to work on these things together. speaker-1: They may need additional supports, Not just one hour of parent training a month or whatever the funder allows. They may need therapy or something like that, right? speaker-2: Absolutely. I think you noted on another thing too that I think is often missed in conversations with or just often missed in provider settings where maybe a provider has high case loads and they miss those signs, right? ⁓ mom is really stressed out. And then that's a missed opportunity too to ask, okay, how are you doing? Like, how can I support you to make sure that you can do your best to support your child? And the example that you brought up, I think resonates with a lot of the families that we work with because it's more, it's a lot of how can we support mom or dad with regulation, right? That's not often the goal that we see with caregiver training goals that gets pushed out to insurance, right? But I think it should be. I can tell you myself, I'm a new mom, my son is too. And it's the whining. It's the whining that gets me. then, know, identification of the function, attention base. Some days I can handle it more than others. Some days I'm like, okay, I can't take it. Like, please be quiet. speaker-0: 100%. speaker-2: You know, so I have a mom right now that I'm working with, similar behavior, not whining, but more of like a flicking of behavior. So she also successfully was able to identify the function, okay, maintain. And I was so proud of her. Yes, yes, really understanding. And those are the light bulb moments, right? When you get a parent who's like, okay, like I guess what, Sandra, like I identified this, like I know that it's attention maintain. speaker-0: place. speaker-2: I just don't know what to do with that information. So help me out, talk me through what would you do, right? So we talked about, okay, this is an attention-maintaining fever. We want to really limit our attention. And I know that it's hard. And I think that's another key thing that we make out of these conversations is like, we often hear providers flat out plainly say, ignore it. If it's attention-maintained, don't give attention. But it's not as easy as it sounds, especially as a parent when I became a mom. and I realized that there were attention-maintained behaviors, it's almost like an internal feeling. I don't know how to describe it. Describe it as like, I can't really, this isn't a feeling really that I can push down. It's not something that I can really ignore, but it is something I'm recognizing that I need to work on ⁓ because then that's going to support me with supporting the decrease of this behavior. Right? So we talked through it with mom. said, I know this is I know it's really hard. know that it's something that is aversive to you. It's something that is uncomfortable for you, but you're going to try your best to limit your attention. instead, limit your attention when that behavior happens. Right? Outside of those behaviors, I want you to focus on providing your attention for the behaviors that you want to see more of. Right? So if we're flicking for attention, you are providing attention when ⁓ your child is giving you their hands for yourself, you're saying, hey bud, like, I love that you're playing nicely with your thing. You're playing nicely with mom. I love that just throughout the day, every opportunity that you get or remember to give him that positive attention and limit your attention when you do see that that part of the computer. speaker-0: Yeah. And sometimes it's even helpful to give like to help the parents to brainstorm their own replacement behaviors. Right. What can I do instead? Because, like what you're describing is like that, like that itch that cannot be scratched or like this like volcano that's just coming off and it's going to erupt at some point if I don't like do something here. And sometimes that doing something is fine here. Here, take my attention. Just just hush. Like I can't because also in those moments you have to make I don't know if they're necessarily intentional. by the time you're in that moment, you're not typically being very intentional or mindful. But it's like sometimes you just make these, ⁓ these like just swift decisions in your head of like, what's, what's best right now? Me give in, I just walk, you know, just just walk what you give in. And yes, I've like, strengthened this behavior a little bit, but I didn't yell or I didn't hit or I didn't, you know, I didn't do something that is more damaging to the relationship between the child and the parent because that that can That's real too. mean, we look at these children that these learners that we're providing services for and I know that across the board, we all work for with a variety of children and individuals who need support. But, you know, some of these behaviors can be relentless, right? Some two year old behaviors can be relentless, right? And then yes, it does stop. We got 11 year old. My child, I'm telling you, he's, he's I asked him yesterday, he's coming home from school every day and he's just so, he's just so many noises, so much loudness, so much just big. I think he's like shifting into that. His preadolescence, I think he's hit about headed growth spurt. So it's like this big Great Dane puppy just bounding through the house, crashing into everything. Like he has no sense of his awareness, like awareness of his body because I think his body's growing. So he's having a hard time even knowing. And then, and it dawned on me, I was like, he's got a kind of a strict, more strict teacher. She keeps them very low key in the classroom all day. I said, hey, bud, I know you've already, we've talked about how you have to be pretty still in the classroom. Like she does, your teacher doesn't tolerate much movement in the classroom. But like, what about noise? And he was like, mommy, have to be so silent. So like his little, his little 11 year old body, by the time he gets home, it needs movement and is just like verbal. down diarrhea coming out of his mouth. And so I was like trying to figure out like, okay, how can we balance this? Right? How can I allow space for this, regulate my own behavior and come up with a plan of how can we like, put this into something that's going to be more helpful or even a skill that for himself that he could learn of like how to regulate himself after school. Right? So, and you know, that's just one little tiny speaker-1: I can't control my own behaviors, right? Like that's just me. So, you know, like, I don't know. You can't. No, come on. There are many behaviors of mine that I cannot control. Right. I think that we're all a work in progress. speaker-0: That's just another ADA thing that like I I won't get on that too much but that we do like when we have when we look at our goals for these learners like yeah that's a soapbox I can get on it like really expecting appropriately expecting like realistic expectations right because we're dealing with humans we're dealing with we're doing the children but even if we aren't like we're dealing with humans and none of us have like perfect behavior all the time so and that's what we have to look at too with parents right when we're dealing with parents because You know, lot of parents can feel judged too. So when we're looking at like trying to get that parent buy-in and trust, I think one of the things that's so important that I tried to have with any of the parents that I worked with to the best that I could was build that connection and trust with them so that they would tell me the truth. Because if they're not telling me the truth about how they're, you know, doing what we're asking them to do, that it's not going to help. Or if they're not able to say, I hear your recommendation and it's just not something I don't think I'm going to be able to do that. Can we come up with a different plan? speaker-1: I don't feel comfortable or that's not our family. That's not how our family works, speaker-0: Yeah, so what kind of advice do you have for our listeners of like how to support their team to support the parents and guardians that they work with, you know, with building trust and helping them to see it as like a safe place and like not trying not to bring in like judgment to the game. speaker-2: I think based on a lot of conversations that I've had with providers and trainees over the years, my number one thing really is to you come into a session with your agenda, right? That's a lot of our providers focus is the things that you need to get done within that session. But I, the number one thing that I share is we, okay, let's put down the agenda for a second. Get, get, take the time to get to know the family, their dynamics, what challenges look like in the home. ⁓ cause that's really where. Parents are going to open up and say, okay, we're not going to talk about the report right now. Great, because I have actually a number of things to share with you that happened yesterday. I think just opening up the conversation to collaboration, right? And it's not just me, the provider, the professional, the expert telling you what to do. We want to make sure that our parents are a partner in their child's care because that's what they are. We can't do the service without them effectively. speaker-0: Yeah, that's super important for them to be part of the team. speaker-1: Yeah, something we're trying to build into our client handbook right now is like, what does a session actually look like? What should you expect a session to look like? I was talking to another BCBA and she's like, is that in your client handbook? Because man, I really need that. And I, and then it just, I went down the rabbit hole of, my goodness, this is nuanced, right? Like this is. speaker-0: It's going to look different for every company, even across the speaker-1: Well, every family, right? And so can we hug? Can we not hug? Can they come on our left? Right. And there's just so much going on and like how much parent involvement do you want? And, I think it's really important to kind of, you know, we, we do that a day in the life of a tech or a BCBA when we're interviewing or job posting. highly recommend that. So you almost need that for, ⁓ what ABA therapy looks like. speaker-0: what the sign with your child or with you as a parent is going to look speaker-1: But also like the fact that this is a transition and fate, right? This is a, like, of course, for some learners, it's never right. There's all, they're always going to need support, but for, I'm going to say a majority of the cases, this is a transition and fade, right? So even giving that information and saying like, this is how it looks, right? I think can be helpful. speaker-2: No, you bring up a good point, Stephen, because I think a lot about antecedent interventions all the time. When we talk about our learners, we talk about antecedent interventions. What antecedents do we need to put in place to make sure that we have the most success that we can for our learners? But I think we miss that putting antecedents in place for expectations with your team and for your families is a really important intervention to have, because without those expectations, there are going to be ⁓ miscommunication, there's going to be frustration because parents wasn't told that they were expected to be a part of it. And then now insurance is knocking on their doors. Really the reduction of hours, right? Because it looks like you're not participating in session. A lot of what I was seeing across agencies was whenever I was passed down a case from another clinician, I may have received families, right? Who've had been in services for quite some time already, a couple of years, a couple of months. I learned very early on that I needed to set my own expectations and not expect that the provider before me had set them for me. So every case that came my way, I treated as a new case. I am Sandra. ⁓ This is what sessions are going to look like with me. These are my expectations as a provider as far like little things too like with scheduling. I've had cases come my way where parents were frustrated or there was this mom in particular that was frustrated with me because she was trying to get in contact with me. Um, one day and I was driving a lot of day going house to house clinics, house to house. And I let her know that's a boundary that I set with all of my families. I don't pick up the phone when I'm in my car. That's a hard rule that I, I thought I was in an accident previously. I it's, I don't do that. Oh, but my, my, my last VCBA would drop everything, you know, for, for a call with me. If you need time with me, here's my booking calendar. We can put time aside to make sure, you know, your questions or your needs are met. But here's my booking calendar and ⁓ I'll make sure that your needs are addressed. But I'm in sessions throughout the day and I'm driving. I can't get to you right now. Of course, there are cases outside of that emergency. Mainly, each case that comes my way, I want to make sure I set my expectations so that they have a well-rounded idea of what it looks like to work with me. I think that gets, and same thing again with trainees, with team members that you're working with, ⁓ biggest antecedent strategy really is to set those expectations in place and say, okay, if I fall through with this commitment, that's my bad. Like I'll take accountability for that. speaker-0: Yeah, totally. do think that that is so strong. Yeah, you're right across all levels of what we do, right? With our techs, with our families, with our staff, with our admin people, with whoever we communicate with when we're like, especially when we're treating or providing a service, right? Like, what is that going to look like? And what are your expectations? Or what are my expectations? And how this is how I'm going to show up. so when we go into, I don't know, this might be more applicable to in-home services. But I think there's a piece here that makes sense for clinic as well, right? ⁓ But really taking into consideration the culture and values and not just general overarching culture, which is super important, but even understanding that each individual has their very own specific culture, right? ⁓ And really looking at this as part of the collaboration of the parent being part of the team. But as we're coming up with the treatment plan, whether it's your traditional tier model, whether it's, ⁓ you know, parent coaching model, ⁓ What are some suggestions to be able to ⁓ assess the needs, of course, the skills and the needs and the barriers and the excess behavior or dangerous behaviors? Of course, there's typically so much on the plate when we come. There's so much to look at and we do have to prioritize, right? But ⁓ how do we include parents in that collaboration? speaker-2: in the beginning, ⁓ again, with your attitude and interventions, especially when you're starting out with the data, assessing during the assessment process, ⁓ making sure that you're not just there assessing the child and not having a conversation with them about what it is that you're doing. I think that there's some value in saying, OK, I'm assessing this and I'm assessing that. ⁓ And that is because we would like to see communication skills that look like this or like that. And what can you tell me about, about, tell me more about what you're seeing in this area, in communication or independent living skills. Just really help trying to heavily involve them in the process because you might learn right within that process that, and you talk, you spoke about culture, right? I think a big example that comes up a lot is within independent living skills, how important it really is to use the utensils across cultures. How important really is it to receptively identify different foods that are not even involved in the home? You're not going to find that information out without talking to the caregivers. speaker-0: Absolutely. I had forgotten all about even just the the taxing and you know, like, because that is I mean, not even just food, but like, what's that's a whole nother soapbox of like, what is really meaningful to this individual child, especially if they're an early learner, right? Like, we're getting things going with communication and understanding language, right? It's like, what is important to their life if you know, if they if they've never seen if they live in a climate where they've never had to wear a winter hat and boots, like we'll teach it to them eventually, but it's not important to start with. And so I think too, with the eating and the sleeping and the dressing really being open as a provider, being open. Yes, there's developmental norms. There's, you know, know, the direction, what is it like the steps, right? Like, ⁓ we typically do it in this order of things. But, you know, asking the parent like what is important and being okay with. being a little flexible and looking at it, mean, over again, looking at it differently, I think is super important. speaker-1: I guess there's also that piece of when, when can you say no, because there may be things that the parent and you kind of addressed it a little bit, right? But are those things that it just annoys the parent or maybe they feel embarrassed by the behavior, right? And it's like, you know what, like there are just some things that you're going to have to live with, right? And this is, you know, these are things that we are not going to fix, right? Because they're part of your child and you're just going to have to be okay with it. speaker-0: it, right? Or looking at, oh it got really loud all of sudden. Yeah, I don't know what the... Or just looking at, okay, well maybe if this like kind of going back to the example I gave earlier, maybe something that the provider thinks may not be that big of a deal, but it's a big deal to the parent, like take that into consideration, right? And see how you can meet them, you know, with, okay, let's see if we can try to reduce this behavior or give some replacement behaviors or, you know, give the parent, you know, some suggestions or recommendations of changing their behavior. speaker-2: think a big piece of it too is that help supporting them with that reframe sometimes and that education because for example, a big one that comes up often is compliance based goals. And we see this across cultures too, where parents might say, ⁓ my child doesn't listen to me, I just want them to comply to everything that I say because I'm their parent. They need to show respect. They need to follow everything that I'm saying. And so, yeah, I think what's important there is to support them with that rebranded education and say, you know, we want for our kids to be able to say no, because the reality is when we have a child who is compliant 100 % of the time, that increases the risk for potentially being in situations. Yes. Right. And especially if the overall goal is to support your child with independence, right, as an adult, we want to make sure that while they grow up, they have they have self advocacy skills and that they're able to use them in situations to keep themselves speaker-1: safe. Yeah, that was on my list of things that as self-advocacy is so important, right? And like, I don't know, again, I'm not saying that this is all across the board, but it does seem, I was saying this in another podcast and I'm using this word, like it seems like we're beating the no out of these children. And I know we're not beating them, but do know what I mean? Like we're just saying, you're not allowed to say no. And what are we doing to this child, right? We are putting them in a situation where they're not allowed to say no. So, you know, like that's very scary, right? Especially if it's a child that does have a harder time communicating anyway, right? And then we're doing that. Yeah. So it like, yeah, it's so important that that is a part of all the programming we do. speaker-0: I think it goes into developmental understanding of developmental appropriateness too, right? Because we can have those conversations with parents if there's a particular ⁓ behavior that's annoying them or that they're concerned about, right? And you were talking about reframe, but there's also this thing that happens sometimes to parents of special needs kids or just parents in general. Sometimes we get very me focused and we're like, ⁓ why is this happening to me? Why is my kid having this trouble? Why is my kid making my life so hard? And we do get tunnel vision and we forget or maybe we don't even know and we need someone to educate us. ⁓ In my sense, I know very well and I still forget that, you know, this is part of your child growing and learning and this is part of the phase that they're in right now. Not saying that we can't, not saying that we have to just excuse it as that and not do anything about it, but having that understanding can be validating that, wow. you know, this, thing that's happening right now, this is a thing that happens to a lot of kids at this stage of life. And, know, just not feeling alone can be something is let's think about like a two or three year olds, how many, like those of you who are parents and are listening right now, if you've ever had a two or three year old child who has bitten someone raise your hand, like most of us are going to raise our hand. Right. And so when And this happens with providers too, who are not as educated about the developmental appropriateness. And I've talked about this in other podcasts before. okay, well, biting is a behavior that happens in that phase of life. And there's a lot of reasons for it. And yes, we're looking at functions and blah, blah, blah. But ultimately, we have to look at human first, we have to look at developmentally appropriateness, right? Okay, well, now, if they're biting and it's becoming a routine, we realize, okay, they're biting for attention, or they're biting to gain access to something. Okay, we're gonna work through that. But to have that conversation with a parent of like, yeah, biting is something that happens to most kids at this age or in this phase of development. mean, parents have told me that, it's like that I've worked with it. It feels like they're just always something and they're always dealing with behaviors and they're dealing with this for the rest of their life and their life is so hard. And I'm not saying it's not hard, but it's really easy to kind of ⁓ get stuck in that ⁓ because my kid's autistic, I'm having to with these behaviors. And sometimes I've heard from parents that it's helpful when I help them look outside of that. speaker-2: I think that this is a good conversation to have with parents. It comes up a lot actually where I'll have parents bring up a problem that they're experiencing and they'll seek validation. Like, I can't be the only one going through this, right? And I'll say, no, you're not. You're not alone. You know, I've supported families who are going through what you're going through. know, strategies are going to support people differently. We're going to find out what works best for your child and for your family, but you're not alone. So yeah, again, like not to minimize, yeah, they are having these challenges. It's important to have that reframe, right, and that education. But I also think that it supports them with feeling, I think, less isolated too. speaker-1: So question for you all like completely on well kind of related but like so let's say you get a BCBA that wants your help and says okay I am awful parent training, right? I don't like it. Like you said, right? I'm sweating. It makes me nervous. I don't I can't handle this I'm being told I have to do it and I don't like it It's the worst thing I'm like what what is kind of like step number one for someone in that situation? So that they can get better at this speaker-2: I ⁓ would want to sit down with this person and identify what their barriers are. It could be different for different people. For me, I felt that it was because I didn't really have a structure in place. I didn't go into it with a plan of, OK, what am I going to talk to this parent about? ⁓ But then also knowing what to say and how to assess in the moment if, again, we don't have to be tied to our agenda for an entire hour or two or however long your sessions are. But being able to identify how to support, how to hear the parent and say, okay, this is a moment where, okay, we're not going to be talking about the behavior intervention plan right now because mom is in like high distress, right? So I think that a lot of times when I sit down with providers and my trainees, that's one of the first conversations that I have with them because it's one of the first challenges that they come to me with. It's like, I don't know how to talk to this parent. So we'll do some... Especially with my trainees, like you April, you mentioned modeling a lot for your team. So when I was focusing on a lot of field work training, like I would bring my trainees in with me when I'm doing current coaching. ⁓ And just for them, the feedback that I received at least just from them seeing how my rapport is with my parents, right? I think it was really helpful to see because previous to that, I've had trainees who were very, I don't know how cold is the word that I want to go with. I can't think of anything else right now, but. Again, just very agenda focused and we don't want it to be about that all the time. Like we want to make sure that the families know that this is another human sitting across from you and I want to hear you. I'm hearing you out and I'm going to support you with, I hear you, I see you. If something is on the agenda that we need to get to, I'm going to put that down for now and we'll talk through this ⁓ current problem together. speaker-0: How do you work with your trainees to teach them how to walk that fine line? Because we hear it a lot, right? The BCBAs are saying, oh, I have to stay on my lane. I can't go outside of my scope. I'm supposed, especially with insurance, like models, right? We have to be so very careful with how we state things and how we do things. And so there's a lot of very rigidity as far as going into the session, and can I put my agenda to the side, right? I don't think I'm allowed to, because I don't even think I'm allowed to take water from this family because I have to stay in my lane. can't, like, there's no dual relationship or even question of it. I'm here for your child. And I have X amount of goals that I have to get done in an hour to be able to put in my data. And I'm sorry, I don't have time to talk to you, mom. And I think a lot of times that's the RBT, right? That's the tech. And they're like, when the BCBA comes, then they can help you. like, and then even sometimes the BCBA, like you said, has a hard time knowing how to be open and flexible to hearing the parent and maybe even helping to bring them back to like giving them the space to talk and then knowing when to kind of help bring that parent back in. There's so many skills. speaker-1: to throw one other thing in, right? Like I keep on, repeat this every podcast probably, but like, think the average experience level of a BCBA is three years. And then you add on top of that, like, like they've got 25 cases and like they have, like, I have no other time then to check off my checklist, right? Like there is no, ⁓ hold on. What did they just say there? ⁓ that's way different than what we talked about last time. We should, I should probably investigate that there isn't that ability to listen. Because I don't have time to I don't have time to listen. I have time to tell that's that's the only time I have right now So I'm sure that ⁓ yeah, there's a lot of difficulty speaker-2: I absolutely. think that the system makes it really challenging for us to be human. Yeah. In that sense, because you're right. We need to show up in our notes and submit something substantial to the funders because they're the ones funding the service. So I would say too, it is important for us to be there for our families in a way that is compassionate ⁓ and hear them out. But there's also ways with documentation. And you mentioned this April, we want to make sure that we're Um saying in our scope and not mentioning things that are outside of it that might look potentially like a dual relationship. Um, but let's say, let's say parent parent comes to a session, training session, and they're in tears, they're, which has happened before. And I'm sure there are other providers here on, uh, listening in who might've had a session like that. They had an hour schedule to sit down with a parent. They had, you know, a to-do list to go down within that session. Parent comes. completely breaks down and says, okay, this is what I'm experiencing. How can you help me? Right. So I think within, I think within situations like that, still very important to show up as the human that you are, show that compassion, them out, ⁓ support them in any way that you can. Let's say that a new behavior came up. Okay, let's talk, let's talk through that behavior. What are the barriers that ⁓ you're experiencing to address them? Right. Even if they're not particular set goals that you've mentioned to the funder before, those are things that you can share within your notes, right? Shift that more into behavioral language that I would be happy with, right? Say that, you know, ⁓ BCBA and parent had parent training session today, we focused on ⁓ recent challenges based in the home that looked like ABC. ⁓ We talked through what potential, ⁓ what potential function or or underlying, we talked about maybe setting events of the Steve Bieber. This is our plan moving forward for the next session, right? Because that's what they're looking for. That's what the vendors are looking for. What happened during session? What did you address? What's your plan moving forward? speaker-1: And just like, I don't know, I'll add this like self advocacy skills for the team as well. Right. So for the techs and the BCBAs and saying like the beast, like I just hope that the BCBAs understand how much power they have in this situation because they are in such high demand. And so maybe they could say, no, I'm not doing that way. Right. I'm going to do it this way. I'm going to actually talk to this person. Like I, uh, like they are a human. want to like, this is why I got into this field. It isn't to fill out a checklist. It is right. It's not to write. The report's as fast as I possibly can. It's to help families. That's the whole reason I'm here. speaker-2: It also presents an opportunity to create a new goal that they might need. speaker-1: Yeah, I just think going back to your company and saying, no, we need to change this because obviously the way we're doing it right now doesn't work for many people, right? There's a lot of burnt out providers and how helpful is a burnt out provider? Not as helpful as a not burnout provider, right? And so, you know, if we could do this differently ⁓ and bring the humanity back into this human field, I think that we all would be better. speaker-0: Yeah, we've definitely had a lot of conversations around the that very thing. ⁓ I do think though, it brings it back to experience. When you're just starting out and you're new and you're young and I mean, you learn these things as you go. You figure these out as you go. And sometimes it's hard to advocate for yourself if you don't feel confident in what you're doing. speaker-1: I was gonna say that. or you don't even know what to advocate for. speaker-0: And so I think that's why it's great ⁓ that we have people who are focused in on helping like offering supervision like Xandra does. And, you know, there's quite a few that we've that we talk to and work with who are really out there really helping ⁓ provide a lot of instruction and education and support for for those who are working to become a BCBA and who are new in the field. Right. And that's what hopefully these conversations can can help to to help people know. Like, what to look for even. speaker-2: No, I agree. And that's big reason why I wanted to support with remote supervision, right? I think we all started at that level where we're feeling like not confident, like, you don't know what you're doing. There's still things today that a lot of us as BZBAs, know, 10 or 10 plus years down the road and with experience, ⁓ don't know. And I think the whole point, is to normalize that we're always going to be, we're always students. Right, you're always going to be students. So I like to share with my trainees, like you might feel this way right now, but you're even when you pass your boards and five years and with five years under your belt down the road, there's always going to be something that ⁓ you're going to be learning. speaker-0: And I think it's important to have that expectation as we were talking about expectations. And I think that the second someone, anyone, whether it's a BCBA or anyone in this world gets to the point where they feel like, oh, I don't have anything else to learn. I know everything. We don't want to be there either. speaker-1: Yeah, think reframing this as like you're going to like I had a mentor like I'll always I'll always remember him telling me this or if you're not making mistakes and you're not doing anything, right? So like, ⁓ I think when you're learning and growing, you're going to make mistakes and that feeling comes with it. But right, like that's how you master a skill, right? Is you have to do it. So I think maybe going a little bit more gentle on ourselves for not being able to do this right. And you have to be able to practice it and be okay with not getting it right the first time. speaker-0: And I think that that gives us more compassion. Of course, when we have more compassion with ourselves, it helps. does give us more compassion with others. And that would be kind of my, my ask as you go into your week after listening to this podcast is like really just sitting back and reflecting on that of like how, you were in a role where you do interact with families and parents, caregivers, we've been saying parents, but you know, we're meeting all the caregivers into those individuals and the families, you know, what's some compassion that you could bring to working with them, like that you would want someone to give you, right? Knowing that we're all just in this life learning the best we can, and we all have good days and bad days, and we all have triggers. so I think just ⁓ looking at, how could I show up in one little small way, compassionately, because we can be compassionate and stay within our ethics and our guidelines. In fact, we should be, right? That's part of it. So as we end today, What I'm going to ask you, Sandra, if there is one shift you wish wish business owners and providers would make when it comes to supporting parents, what would it be? speaker-2: expectations, I think, again, they're just trying to get back to your under student interventions, making sure that upfront families know what they're going to get out of this service. Because again, I think a lot of this frustration that come out of families, right, is when they have an idea in their head of how everything's going to go down and it goes differently. So I think to be very transparent about what your commitment is to them is going to be very, very helpful. And I can't say confidently that I've seen that throughout my years across different ⁓ companies. I think that is a good place. speaker-1: Sorry. For practitioners that are burnt out, do you have like a, again, just kind of a first step or is there something that you would recommend that they do to kind of start their journey to get out of that? speaker-2: for them to really look inward and identify what their personal barriers are that might look like for a different, that might look different, right, for different people. ⁓ I think earlier, earlier you mentioned April about how, you know, there are different parts of this work that people just don't enjoy and that's okay. Like people are entitled to have their own preferences. They're entitled to have different parts of the job that they love and different parts of the job that they hate. Like I mentioned, I didn't love parent training when I first started out, now I do. ⁓ It's my main focus now really aside from my remote supervision. But I think in that self-reflection, people also need to identify what fills their cup. If it's parent support, then please come join us. We have a school set up. It's a community that I call the Parent Coach Collective. ⁓ We are a group of BCBAs and trainees who are really supportive of the parent-led model. ⁓ Our members are business owners who that is their main model. They're doing parent coaching. ⁓ We have other providers who are employed with different organizations and they're intrigued, like they're interested in learning more about parent coaching. They want to just refine their parent coaching skillset and just see how leaders in this space are working within this model and how does it look different than traditional models. And so it's really just a space that I wanted to create. for us to really have these kinds of conversations about how to better support families. What does that look like if I wanted to focus on parent coaching as an independent practitioner? And yeah, before this call, I was listening to one of you guys' episodes and I'm forgetting the title about it. But the discussion was around the isolation that practice owners sometimes feel when they open up their practice and there's no one else really that they can lean on. And so the feedback that I'm receiving within the parent coach collective is that That is what this is providing to them, right? That sense of camaraderie and just being able to lean on a community to support each other. speaker-0: That is really beautiful because we need more of that. We need as many spaces of those that we can provide. And especially ⁓ it's specific to parent coaches. You can go to the show notes and you will find all of the links ⁓ of where you can find Zandra and reach out to her and on social media and her website and all of that. So you can go check that out there. And then also if you haven't already come, join us at the our support group that we have for our business leaders and we have moved over to Discord now so that we can continue to offer that as a free support and we have our monthly meetings and so we'd love to see you over there. That will also be in the show notes and at the time that this is airing, Stephen's book will be out in the open, out in the world live. So please click on the links in the show notes and you will speaker-1: gotta stop putting that in. speaker-0: and you will be able to know how to access Stephen's new book. He hates it when I do that. Makes it even more fun. speaker-1: I'm glad that, see like this, how do I change that behavior? speaker-0: You don't want to your life would be dull and boring. ⁓ really? Well, thank you so much, Sandra. I really appreciate your time and your expertise and just your openness to be able to have this conversation. All right. Well, thanks everyone and we will see you next week. speaker-1: See ya. speaker-0: Thanks for joining us on ABA Business Leaders. speaker-1: We provide mentorship, courses, handbooks, billing support, credentialing, HIPAA support, web design, and more. Everything you need to build an ethical and sustainable ABA practice. speaker-0: You can find all of our resources at 3piSquared.com speaker-1: Don't forget to subscribe and share this podcast with other ABA business owners. speaker-0: We'll see you next time and remember, you don't have to build your practice alone.