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

Episode Transcript
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SPEAKER_02 (00:00):
Welcome to ABA on Tap, where our goal is to find
the best recipe to brew thesmoothest, coldest, and best
tasting ABA around.
I'm Dan Lowry with Mike Rubio,and join us on our journey as we

(00:23):
look back into the ingredientsto form the best concoction of
ABA on tap.
In this podcast, we will talkabout the history of the ABA
brew, how much to consume toachieve the optimum buzz while
not getting too drunk, and therecommended pairings to bring to
the table.

(00:43):
So without further ado, sitback, relax, and always analyze
responsibly.

SPEAKER_04 (00:55):
All right, all right.
And welcome back to yet anotherinstallment of ABA on Tap.
I am your co-host, Mike Rubio,along with Mr.
Daniel Lowry.
Mr.
Dan, good to see you yet again,sir.
How are you?

SPEAKER_02 (01:09):
Doing great.
Very, very excited.
This is two guests in a row, sokeeping up the momentum and
really, really excited fortoday's guest.

SPEAKER_04 (01:15):
I got to break into a little bit of an introduction
here.
We've been doing this for almostfive years, Dan.
And at the beginning, it waskind of like crickets out there.
We weren't sure who waslistening.
And then all of a sudden, on oursocial media page, which didn't
have a very far reach, I thinkwe were just on Facebook, we
started getting trolled.
And it was like, wow, this isexciting.

(01:36):
People are listening, and theycare to argue with us.
And then we realized theyweren't even listening.
They were just arguing with us.

SPEAKER_02 (01:43):
And they saw ABA, and that was it.

SPEAKER_04 (01:45):
And then most recently, which is super, super
exciting, we've been getting ahost of folks that have got a
lot of good things to say.
So we're excited to haveJennifer Fitzpatrick from the
CPABA conference coming up herein October, I believe.
Yeah, great.
Jennifer, we're so excited thatyou found us.

(02:05):
We're so excited to make aconnection with you.
I need to introduce you with alittle bit more, which is to say
we don't often pre-interview onABA on Tap.
We just kind of fly by the seatof our pants.
But when we got your email, wesaid, wait a minute, we got to
meet this person first andfigure out a little bit more
because you have a lot to say.
You have a wealth of informationfor us today.

(02:28):
We're going to do our best tokeep up with you.
I don't know how to say thathere on ABA on Tap, but it's the
truth.
I think you've got a wealth ofexperience.
You've got some very importantthings to talk about.
We might even see controversialfor some people, and that's
okay.
We're very glad to be able tohost that.
So without further ado, JenniferFitzpatrick, tell us a little

(02:49):
bit about this conference andlaunch us off here today.

SPEAKER_00 (02:52):
Well, thank you for having me.
And yes, we are trying to getthe word out about the
conference.
And you guys have been sohelpful in that sense.
The conference was establishedby a group of us.
We just got together.
I had gone to ABAI.
I had gone to a couple otherconferences.
My daughter is graduating withher SLP and her BCBA license.

(03:13):
I had been out of the field fora while.
I thought I'm coming back intothe field.
And the changes just in theyears that I had been out were
astronomical to me.
was shocked by what I saw.
And I said, we really need tohave a conference at one that's
going to hit clinical workbecause we're still talking a
lot in theory.
And I'm not sure why ouruniversities have not put

(03:35):
programs in place.
I'm not sure why our boardhasn't established like a
secondary certification that isrequired because we have sent
these people out into themedical community with a lot of
liability, a lot of, you know,there's lots of issues.
I mean, there's lots of thingsthat these young 24, 25 year
olds are doing and don'tunderstand the implications of,
and we don't have enough senior,I think BCBAs out there to help

SPEAKER_01 (03:58):
us.

SPEAKER_00 (04:00):
They, it's just crazy.
And so I, and then when I wentto these conferences, I was
seeing things being presented inisolation, which in themselves
is not a problem.
But if you have no otherreference point to this, you
have no other, um, there'snothing, there's no other way
for you to understand this.
You're isolated and you're onesided.
You're, you're getting one view.
So this is what CPABA is tryingto correct.

(04:22):
We're trying to put together,um, professionals in the field
who have different views becauseguess what?
Different views are good.
It's what makes our system workif you have different views it
pushes it challenges you sowe're putting different views on
the panels they're going topresent the research they're
going to present how it actuallylooks in practice because just
because something works in saySan Diego California does not

(04:45):
mean that's going to work inBoise Idaho or going to work

SPEAKER_01 (04:48):
in

SPEAKER_00 (04:49):
Boston, Massachusetts.
Sure.
Yeah, and legally.
I mean, it's not even just likeit might not work.
There's legal reasons.
I mean, there are places in thecountry like in Oregon where
they have very strict rules onrestraints in schools and even
in practices versus in Idahowhere restraints are not an
issue, so to speak.
And so these are the real issuesthat people are dealing with.

(05:11):
And so we have to startaddressing them because what's
happening is is that we don'thave the training and experience
in the field so people arealtering practices or altering
methods or we got i mean we havebusinesses that have business
models that by all standardswould not meet good practices
but yet they're being They'regoing all over the place because

(05:32):
why?
Because nobody's pushing back.
And the pushback should becoming from BCBAs, but we have
such an untrained staff.
And I know people hate when Isay that because it makes, I'm
somehow criticizing, but I'mnot.
I'm saying you can't think thatyou at five years old, or five
years old, but five years ofexperience can be a clinical
director.
But yet we have three years andfive-year-old people with that

(05:54):
experience are clinicaldirectors and running huge
portions of things.
They don't have the experienceand the understanding and the
legalities behind what they'redoing.
So we just have a free for allgoing on out there.
And there's got to be a placewhere we can start controlling
this.
And this is what CPABA is about.
It's not about coming in andpresenting new research.
I mean, you can if you want to,but it's more about how to get

(06:16):
through.
And then there's an underlyingtheme to CPABA that is also
trying to bring in somestandardization, which I know is
a really bad word.
Everyone hates that, too.
But we need some standardizationto try to help give some methods
to ensure that, one, you canimplement new research.
Right now, when research comesout, I mean, unless your company

(06:39):
or your group is embracing it,it's really hard to put it into
practice.

SPEAKER_01 (06:42):
Sure.

SPEAKER_00 (06:42):
I mean, I could name five of them right off the top
of my head right now.
Break programs.
Unless your organization doesit, you can't put it in
practice.
There's got to be a vehicle forresearch to come into clinical
practice.
Standardization ofdocumentation, standardization
of training would giveresearchers some background.
There's got to be a way to startconnecting like what activities,

(07:03):
what methodologies, what thingswork best with mediators.
All of that has got to come intoplay or we're just going to be
out here floating and we'regoing to continue getting more
and more craziness in the field.
So CPABA is trying to be...
that place.
We

SPEAKER_04 (07:21):
appreciate that very much.
I believe you mentioned thatyour daughter introduced you to
ABA on tap.
And if you listen back to someof our early episodes, we might
be coming actually from theother direction and saying, hey,
guys, a lot of what we've donein the past, at least for us in
in-home treatment, for example,has been very authoritarian.
We don't want to go that route.
Somebody might hear you talkabout restraint and fall right

(07:44):
into that authoritarian pieceand say, we're going to throw
that baby out with thebathwater.
Nobody does I'm going to pass itover to Dan here in a while
because he's our resident experton restraint.
Well, not necessarily restraint,but something related.
And you can give us your insightthere, Dan.
Now, I can go back to early inmy career, the first time I
worked in a clinical setting, anon-public school with sort of a

(08:06):
wraparound psychiatric clinic onsite.
um i spent an entire yearworking there i did one
restraint and it was almost iwas almost coaxed into it i
remember going through thesetting telling myself they're
they're using restraint aspunishment here and uh it
doesn't look good it doesn'tfeel good it happens way too

(08:27):
often they think it's teachingsomething i don't think it is
i'm pretty young professional atthis point too just trying to
figure this out So I was gladfor that experience.
I was glad for my mindset atthat time.
I know during our pre-interview,you mentioned the same thing.
If somebody hears you talkingabout this, they might
erroneously think that you'repromoting restraint.
You're not necessarily doingthat.

(08:48):
You're positing restraint.
You're trying to find the rightplace.
Mr.
Dan, let me kick it over to you.
Any insight on that?

SPEAKER_02 (08:55):
No, no.
I just really liked your inputwhen we talked in the
pre-interview that youmentioned.
You said you've done it maybe ahandful of times, I think you
mentioned, Jennifer?
Yeah.
Is that right?

SPEAKER_04 (09:07):
Over how many years?
20, 25 years, 30 years?
Almost 30.

SPEAKER_02 (09:11):
But I really liked the framing that you put into it
in our pre-interview.
When you mentioned, you know, wehave the word restraint, and
that will get a visceralreaction for some people.
Yes, sir.
But I think your premise, andplease, you know, correct us if
we're wrong, is that you weresaying that there is a large
subset, not large, at least asubset of population that we

(09:32):
work with that does have prettysevere behaviors.
And because people areill-equipped to deal with the
maximum level that that behaviorcould potentially get to, that
people aren't just taking thesepotential clients or these
individuals that need servicespotentially more than anyone
else does.
And because the demand is somuch higher than the supply,

(09:52):
it's easy for a lot of theseoutfits to just say, well, we're
just going to take theindividuals that don't escalate
to this level.
as a result of not having thatpotential tool in their toolbox.
So I'll pass it back to you,because I wanna make sure that
you explain it the way that youwant to explain it, but I just
thought that was a really coolexplanation that you had,
because when you first werelike, ah, restraint needs to be

(10:15):
more I wouldn't say you saidneeds to be more available, but
it needs to be an option.
I was like, huh?
But then you kind of brought itback around of, oh, well,
because these people aren'tbeing able to be served because
when they get to that level, thepractitioners don't know what to
do.

SPEAKER_00 (10:31):
Yeah, no, I think what concerns me about
restraints, and I will say this,is that.
the untrained and not actuallydealing with the issue is the
most dangerous thing we can havein the industry because if you
get up in a situation and youhave to restrain and you have
been consistently against itthen you don't even know how to
intellectually, in your mind, ina quick moment, figure out

(10:53):
what's your next steps, whatyou're going to do, how do you
get yourself in and out.
It's dangerous.
It's absolutely the mostdangerous situation, and it's
dangerous for everybodyinvolved.
So when I hear practitionerssaying they're not going to be
involved in it, I'm like, okay,well, first of all, one of the
speakers who's going to speakwas actually in a level five
hospital, and she also works ina high-level situation with

(11:16):
group homes with children, andthey had really severe
situations.
and it wasn't just children withdisabilities they had children
with other juvenile situationsand she's like you can't get
workers to do this anywaysbecause who wants to go in and
get beat up every day but if youdidn't have some form of
restraint involved especially asa woman in a room with let's say
a couple guys who are you know15 and 16 years old who are you

(11:39):
know 200 pounds you now have adanger situation and so she says
we had to do restraints wellThat's the thing that worries me
is that we have used like thisovergeneralization.
And by the way, I think a lot ofthings that are happening in ABA
are overgeneralization.
We have taken this thing and wejust applied it across the
board.
And what I'm saying, the nuancesare really the important thing

SPEAKER_01 (11:59):
in

SPEAKER_00 (12:00):
this.
I don't want to suggest we allgo out and say, and by the way,
I have been very clear with,like I said to you guys before
and with other people, I do notthink anyone with less than a
year experience in the field whohas not worked full time and has
not worked under a very welltrained person should even be
able or even have it in therepertoire because of the fact
that it is something that couldgo really bad, really fast.

(12:23):
But it does have to be dealtwith and we do have to establish
it.
And I do think that if we forcethe board made it a requirement
that everyone had to do arotation in their clinical group
work, that they had to gothrough a severe like a level
five hospital or go throughsomething of that nature, all of
a sudden this conversation wouldchange to finding practical

(12:44):
solutions.
Because there are places, like Isaid, there's a group in
Australia right now that is notallowed to do restraints in the
way we would considerrestraints.
And they have been highly,they're one of the biggest
clinics in the world, actually,and the clinic in Australia.
And their research is absolutelymind boggling and they have been
able to do it.
And that happened because of thefact that people who were

(13:04):
experienced sat down and came upwith a solution people of
different viewpoints peoplecoming from different
backgrounds and that is what ifeel that scares me the most
about our field right now isthat we're not seeing that
anymore we're seeing people overhere who aren't talking to
people over here we're callingeach other hitlers we're calling
each other you know you'reimmoral and the problem is is

(13:27):
that that is never going to getto a solution yep that is what
we're trying to do at cpa bawe're not advocating to do
restraints we're advocating thatwe talk about it and come up
with the best solution possiblefor all people involved because
it's not just a child involvedthere's you got parents and you
got um bcbas you got bts it is ait's a huge issue that needs to

(13:51):
be dealt with and i just thinkeverybody's running from these
issues because It's like theyjust don't want to deal with
them because of the fact we justwant to say what we want to say,
have our opinion, and we want togo on our way, so to speak.
And it's just not.
It's almost like a cult.
I hate to say that.
We're all in these little cultsin our homes.
Sure.
You know what

SPEAKER_02 (14:07):
I'm saying?
Yeah, I mean, that's why westarted ABA on Tap, to be honest
with you, is the discussionpiece is we wanted to open it up
because there's this hugeanti-ABA movement and people
that are very dissatisfied withthe way the ABA service is being
provided.
And we're in the field and we'relike, well, if this overtakes,
then we have no field to work inanymore.
So let's look at the legitimacyof it.

(14:29):
And looking into it, it's like,okay, well...
They make a lot of...
And number one, who am I to tellanyone what their experience is?
I'm saying kind of the movementas a whole versus anyone's
individual experience.
Makes a lot of legitimatepoints.
That being stated...
not all of them are legitimate.
Again, they're legitimate totheir specific situation, but

(14:51):
maybe they're looking at themicro rather than the macro.
The

SPEAKER_04 (14:54):
over-generality that Jennifer's talking about.

SPEAKER_02 (14:57):
Exactly.
We just set out to say, can wecreate a discussion between
people who do have a lot ofexperience in the field and
people that are really upsetwith the field because right now
this is what people are getting.
This is the brew that people aregetting, so how can we try to
make this brew more...
reaching to a wider audience soi think that's kind of what
you're saying as well jenniferright of like that there's

(15:19):
there's a lot of people on oneend and a lot of people on the
other end and like mikementioned before we got on we
got trolled in the beginningnone of the people who trolled
us listened to an episode youcould tell because the things
that they were trolling us aboutwere things that we discussed in
the way that they would haveliked us to discuss in the
episode but they just saw abaand they were like it's inhumane
don't do it it's total crap Theydidn't even listen.

(15:39):
They weren't trying to listen.
And I think, Jennifer, that'swhat you're saying, right?
With the conferences to justbring people together so that
people can listen to both sides.
Because at the end, you canprobably find somewhere in the
happy medium.
But everybody on the other endjust not wanting to listen can
create some less than desirableoutcomes.
Am I reading you right on that,Jennifer?

SPEAKER_00 (15:59):
Yeah, I think the other part about it, go even a
step further, is that when youtalk about this whole like ABA
is abusive or ABA is this andthat, right?
okay let's just let's assumethat it is let's just go with
that theory right and let's justsay i would want to take these
same people and i want to bringthem into a hospital and i want
them to sit down and i want themto see what it's like to do have

(16:20):
three-year-olds who are verysick two-year-olds who are very
sick one reason why when you getinto cancer units and when you
get into some of these placeslike when you get into all-timer
units i mean have you ever hadto put a catheter on somebody
who doesn't understand becausethey have alzheimer's what
you're doing Okay, if you wantto see stuff that is really just
is going to cause you to havemoral and mental anguish, let me

(16:43):
take you into hospitals and workwith sick patients and the
reason why I say that is becausewe act as an ABA is such a
public thing it's in the homeit's intrusive it's you are
right in that home with thatfamily so everything you're
doing is being observed andbeing part of it and then you
have to translate that into thefamily network and make that ABA
part of their daily lives sothis is very intrusive it's very

(17:05):
part of it so in that sense ABAis on display and I think that's
why you see so much of ABA beingattacked and you don't see these
other parts of the medicalcommunity because it's in
isolation.
Okay, you would never have afamily in a room while you're
putting catheter in so theydon't get to see that.
But let me tell you, everyone inthat room is experiencing it.
And if they had the vitriolcoming from the public calling

(17:28):
them abusive I don't think wewould find nurses and and we
would not find staff who wouldbe willing to do it and yet it
has to be done because someonewould die if it didn't get done
kind of thing and I think that'swhy when you think about ABA we
have to remember like when wetalk about masking for example
which is a big deal do you guysrealize SLP spend probably 25 to
30 percent of their all theirtherapy is on masking.

(17:51):
They just call it differentword.
I know that because I also havea background in language and my
daughter's an SLP.
And she was shocked when she sawall that.
She's like, well, we do this,mom.
Is this wrong?
And I'm like, no, honey, it'snot.
I mean, masking, I understandthe reasons behind masking, but
I don't hear vitriol going afterSLPs.
And they teach it at a hugelevel.

(18:11):
Why?
Because it's not on display theway ABA is.
And the thing you have tounderstand is that when you talk
about human rights, I amabsolutely into human rights.
I was part of the group thatsaid I was advocating before it
became well known that women,for example, if you go into the
hospital and you're in ateaching hospital, most likely

(18:32):
you were going to have a breastexam done and you were going to
have a pelvic exam done withoutyour permission and without you
knowing and for no apparentreason, because basically they
cannot teach doctors in GYNunless it is.
I knew about this 30 years agoand we were advocating And I was
told to shut up and sit down,just like all the other women
were, because how else were wegoing to teach these poor

(18:53):
doctors how to do this?
And I'm like, you can't getconsent.
So when we talk about consent, Ialways want to kind of go like,
I can't believe I'mtheoretically on the other side
of this right now, because I wasone of those early advocate to
advocate for women's rightsinside of health care, because
we had so little.
I was one of the first to bepart of advocating for girls to
be diagnosed differently, tohave different treatment,

(19:15):
because girls presentdifferently and not to So I do
have a very strong affinity forthat type of understanding
because I see it and I see howit's done.
I mean, we have horribleoutcomes in healthcare for
minority populations.
Even if they have the sameeducation level, the same
economic levels, they still havepoor outcomes.

(19:36):
So I'm on board with that.
But I also want to tell peoplethat they need to take a step
back and put this in context.
They need to take a step backand look at this in perspective.

SPEAKER_04 (19:46):
Absolutely.
You bring up the idea ofmasking, for example, is
something that we wereintroduced to during one of our
first attempts to bring oncriticism of ABA to ABA on tap.
It was Chloe Everett, I think,that first, at least for me, you
know, gave me the first bigintro to masking and how
problematic it could be to theneurodivergent community from

(20:06):
her perspective.
You bring up a really goodpoint, which is People get to
see these more intrusive, moreauthoritarian methods that we do
have to use many times for theprotection of our own clients.
They're right up front.
And then I'm going to askanother question, and Mr.
Dan, I know you've got somethings to say.
You don't have to answer this.
We can contemplate this forlater.

(20:27):
But one of the questions we askhere on ABA on Tap is what can
we do differently with regard tothe application of something
like masking that might make itmore user-friendly?
How do we modify the ergonomicof masking?
And you probably have someinsight into that as with your
daughter.
Mr.
Dan, what did you have for

SPEAKER_02 (20:43):
us?
Do you want to go ahead on thatone first, Jennifer?
You

SPEAKER_00 (20:46):
know, when people ask me about ABA in general,
about what I would do and Iwouldn't do, like social.
So masking, I think, is reallyimportant.
And people, I'm actually on theopposite of this because what
keeps a community, what keeps ustogether is our social norms.
That is what, I mean, that'swhat holds us together.

(21:07):
And part of the reason why weare in trouble right now around
the world with mental healthnessis because our communities are
breaking down.
What we used to do, like the waywe used to interact, where we
used to interact, places in ourcommunities are gone.
We're losing them.
We're now, the online presenceis now changing how we interact.
So we understand that if we donot bond and we are not

(21:27):
integrated as a community, wehave serious problems mental
health-wise, and we're seeing iton full display right now.
So social norms is what bringscommunities together.
It's those social norms.
So what I say is, do I want to,and by the way, again, I am a
woman feminist who has beenfighting for years, and I was in
a very, very predominantlymale-dominated situation, and

(21:50):
I've lived overseas in somepretty male chauvinistic
societies.
So would I want to encouragesocial norms that would put me
in a position that would bewrong?
Absolutely not.
I do not agree with that, and Iwould never tell a person to
mask or social norms that wouldbe detrimental.
However, there are many socialnorms that are not detrimental.

(22:10):
And we teach children that andwe expect children and we expect
adults to follow those norms.
So, for example, I mean, I knoweverybody had to be flying and
had to see the news and saw allthese people acting crazy on
planes.
Not only was safety issue, butcome on, you guys yelling at
flight attendants and actingcrazy on a plane.
It broke all of our socialnorms.

(22:30):
And we were like, people take aseat, relax, chill.
There is no reason why you wouldnot teach that across the board
to every person in our society.
If a child could not dosomething, if there was some
reason that they cannot do it,That's a whole different story.
And then I say, let's figure outlevels of ways around it to make
them more adaptable intosociety.

SPEAKER_04 (22:52):
Sure.
So

SPEAKER_00 (22:54):
go ahead.

SPEAKER_04 (22:56):
Maybe those issues all over a different type of
masking.
But I digress.
Maybe too soon.
Mr.
Dan, go ahead.

SPEAKER_02 (23:03):
So I guess a question that I would have for
you regarding that is.
Yeah, totally.
I think it would be ridiculousfor people to say that they.
there doesn't have to be somelevel of masking, right?
Like I have to wear clothes whenI go out, right?
I could say that I want toexpress myself, but there has to
be some level of masking withsocial norms and also within the
rights.
My rights can't infringe on yourrights.

(23:24):
My question would be, wouldthat, so I think one of the
alternative arguments that couldbe made is that, yeah, masking
makes sense maybe in certainsocial circles and it's also
relevant to those certain socialcircles because like maybe
dressing up like a furry mightnot be acceptable like at work
or something.
But if I'm with my furry group,then I can dress up

(23:45):
hypothetically like a furry.
All of a sudden, I'm a furry.
But nonetheless, potentially notwithin somebody's home, right?
So is that potentially one ofthe arguments that's made of,
yeah, I can choose when I wantto go out, and then I can choose
knowing that I'm going to haveto mask in this situation.
But if I'm being forced to maskin my own home and behave and

(24:05):
express myself in a way that Idon't resonate with in my own
home, is that different thanwhat you were saying, Jennifer?

SPEAKER_00 (24:11):
I think the big thing that you use, which has
been always my big thing, isbecause, again, I'm going to
use, because I grew up in adifferent situation, I knew the
rules and I could choose to notfollow the rules or to follow
the rules.

SPEAKER_01 (24:29):
Sure.

SPEAKER_00 (24:29):
Often what I see with children in autism is that
they don't know those rules.
if you've ever been in aclassroom with kids who come
from say a lower economic socialsituation and they're put into
say a room with a whole bunch ofhigh functioning um a higher
income and they're gettingrejected because there's um
problems with behaviors it is itsounds horrible right everyone

(24:54):
gets upset when they when i saythat but i said if you actually
teach in a first gradeclassroom, you see it and it
breaks your heart because thechild who's over here doesn't
understand why they're beingrejected.
They don't understand even howto be nice, giving them their
food, giving them giving theirtoys doesn't get them a door
through to that group.

(25:16):
It's the behaviors that thatgroup recognizes.
It's almost like it's all likewater seeks its own level kind
of thing.
They go to where it'scomfortable.
So here's what I have a problemwith when people say, I don't
want to mask and you shouldn'tbe allowed to teach masking.
If I'm teaching someone who hasthe ability to make that choice,
then I'm giving them freedom.

(25:37):
I'm saying you can either do itor not do it.
but the problem is is that manypeople don't even know what it
is that that they need to do inorder to enter into whatever
they're doing they have nochoice because they you can't
choose something that you haveno options to and that's where
i'm saying like if someone saidto me i don't care like i i'll

(25:57):
be honest with you i work inmost of our profession we do
have some people who are on thespectrum i've had friends that
i've worked with who were justlike are not friendly at all
they choose that I'm good withit.
We're all good with it.
It's our choices.
But if they wanted to havefriends but didn't understand
why or how, that is a realproblem.

(26:17):
Because once again, I'm going tocome back to this whole social
network thing.
We are humans.
Humans like living, like we'llcall them packs.
We like to be together.
And the fact that we're sodisconnected already and our
society is so unwilling toaccept each other the way we
are, If you add to that theseother antisocial behaviors,
which, again, if you want tocall them whatever you want to

(26:39):
say it, it causes division.
It causes it separates thesepeople.
And I'm saying if they want tobe separate, that's one thing.
But at least give them theskills and the opportunity to
choose.
That's all I'm asking people togive.
Open up the door.
Don't call masking a bad thing.
Just

SPEAKER_01 (26:54):
share.

SPEAKER_00 (26:55):
allow people to choose if they can choose and
they can choose which way theywant to go

SPEAKER_04 (26:59):
yeah yeah the general idea here being that in
a general sense the idea ofetiquette or being cordial I
mean that's constant masking formost of us and most
circumstances, to be fair,right?
I mean, no.
You just mentioned being at workand somebody doesn't want to be
nice, somebody chooses to benice, you still have to
subscribe to a certain code ofconduct.
Otherwise, one of you is goingto be, you know, outed or not

(27:21):
going to be around anymore.
So, I mean, that's in generalmasking.
And then, again, the question ofhow authoritarian is the
application of that masking interms of the person's choice.
So, on one end, we might notgive somebody a choice but to
mask.
On the other end, I think you'rethe risk of assuming that
somebody isn't capable ofmasking and then we don't teach

(27:42):
it at all and we leave themdevoid of Yeah, no, thank you

SPEAKER_02 (27:54):
for explaining that.
I think you did a really nicejob because, like you're saying,
masking kind of has thisnegative connotation, right?
And there's a place for it andthere's a place not for it.
And on either end of thespectrum, it can be abusive on
either end, just likemanipulation or...
consequence right people hearthe word consequence they
automatically think it's goingto be something negative or
manipulation they think it'ssomething bad but we manipulate

(28:16):
anybody we do a first thingcontingency right

SPEAKER_04 (28:18):
so reinforcement consequence all mean punishment

SPEAKER_02 (28:22):
correct absolutely at

SPEAKER_04 (28:23):
least in the public eye

SPEAKER_02 (28:24):
so I think what you're saying is the word
masking like any of the termslike there's there potentially
is a time to teach it and if wedo it with care and compassion
there's it's not necessarily abad thing but we noticed that
too with some of the trolls thatwould come up Initially, they
would hear a certain word and wewould be down a rabbit hole.
And it's like y'all don't evenwant the nuance or hear the

(28:46):
nuance.
You just hear the word.
So thank you for explaining it.
I want to make sure that we giveyou adequate time to explain all
of your your things that you'rebringing forth.
I want to go back.
You brought up a pretty salientexample about the it wasn't the
chemo ward.
It was the catheter in the inthe hospital.
So obviously in hospital, in anymedical procedure, it's always

(29:06):
risk versus reward, right?
So I want to ask you and haveyou elaborate on.
So in your example, you said,you know, yeah, in these
situations, it could be death,which is the alternative.
And I think Mike is a dad ormost parents, when death is the
alternative, they're willing totake a willing to risk a huge

(29:27):
meltdown and a lot from theirkids.
And one thing that you broughtup was that one of the reasons
there's not the vitriol behindthat is because it's behind
closed doors.
The other could be becausebasically the alternative is
death.
People are willing to risk a lotmore.
With autism, the alternativeisn't death.
So what is your thought aboutthat?

(29:49):
Was my question clear or shouldI articulate

SPEAKER_00 (29:51):
it better?
No, no.
I agree with you on the sensethat, I understand your
question, but I disagree withyour premise.
Okay, please.
I think death would be easier ina lot of these situations.
I think if you've ever worked ina school and you've ever seen
kids isolated, see, what's worsetoday than it was 30 years ago
when I was in school or 40 yearsago was we used to get bullied,

(30:13):
right?
But you know what?
When you're being bullied,that's bad, but they see you.
Today, they just ignore you.
go talk go into schools theydon't bully you they just ignore
you so if you don't fit the normof what's going on in school you
don't exist anymore and I wantyou to think about that we as
society have created apopulation of people who just

(30:37):
don't exist so I disagreecompletely and I think it's also
a sign of how we just don'treally understand mental health
and we don't understand what'sgoing on in our world being
isolated is not being ignorednot being seen i mean i'm over
50 now and um i i rememberreading about how women when we

(30:58):
change how we become lesssignificant in populations and
i'm experiencing that mydaughter is blonde blue-eyed
beautiful and she walks in andthey attend i mean they run up
and attend to her when we gointo stores i walk in today i
can walk the whole store and noone even tends to me i'm
becoming unnoticeable and otherwomen my age people tell you
that and as we get older it getsworse sure so what i'm saying to

(31:22):
you is that is that when youtalk about these things that
anything that is isolating achild from their world out there
i think that should be takenwith the same grain of salt as
if they're going to die becausethat isolation is going to lead
to serious mental health issueslong term and it's going to just

(31:44):
fragment our society more weneed strong families we need
strong communities we needstrong our schools are in
breakdown right now everythingis breaking down because we
don't have those things and themore we are connected the more
we are structured and we havethe the those interconnections
working the better we supporteach other and the better we do

(32:05):
as society and we have lessfights as society we have less
arguments we are allowed we weallow diversity Do you realize
that the very argument thatabout diversity and about those
things come into play wheneverybody in that society is
interconnected and their needsare being met?
When we see people attackingother people and going after
other people, it's because ifyou actually talk to that

(32:27):
person, their needs are notbeing met and they're angry
because we are trying to placesomebody else's needs above
theirs.
So when you listen to peopletalk, you will hear that over
and over again.
Like today, like when you listento politics, why do you have
these groups fighting againsteach other?
It's because the person's needsare not being met.
And so, no, I think that we haveto figure out a way to help

(32:50):
bring people together.
And that means we have to beusing our social skills
training.
I mean, I think neurotypicalkids need social skills
training.
So I'm not just advocating forjust special ed kids, okay?
But we need to teach them.
And the kids who need moresupport, we shouldn't be denying
it to them.
We should be giving it to them.
And whether they choose...

(33:10):
In the long run, how they do it,I mean, every child should have
a choice over their clothing andover how they act and how they
interact, what groups are partof all of that.
I agree with.
But I would also probably be onthe extreme side, and I'm
probably going to upset a lot ofpeople.
but I'm going to say I thinkkids have to join groups like I
don't care if you join the bandI don't care if you join

(33:31):
basketball I don't care if youjoin chess I don't care what you
do but if I were a parent Iwould force my kids to join
groups in the high schools andin the and then middle schools
and then um and find art schoolI don't care pick a group art
school do something because wehave to help these kids get
integrated into society,whatever that is.
So, yeah, so I'm on the otherside of it.

(33:54):
I think mental health is ournumber one problem in this
country right now.
It's

SPEAKER_04 (33:58):
an interesting philosophical paradox that
you're presenting.
And I think that we've talkedabout this or we alluded to this
in our, you know, in ourprevious episodes.
The idea that You can isolate aperson in this circumstance or
in this example, at least in acouple of ways.
One way is to make theirtreatment so specialized that
they are so different from otherpeople.

(34:21):
And then you're talking aboutthe other extreme, which is
sometimes people saying, no,just laissez-faire, let this be.
And then you're not getting theparticular individualized
treatment that you're supposedto giving your basic needs.
So it's an interesting paradox.
I don't know if either of youguys want to comment on that.
Anything?
Yeah,

SPEAKER_00 (34:40):
I think that moderation, I mean, we cannot
live in moderation in thiscountry right now, and I don't
know why.
Either you are so one way or sothis way.
And I guess I live in moderationbecause, like I said, I live in
two states that are literallythe most conservative state in
the country, and then I go toone of the most liberal states

(35:01):
in the country.
And I think people are people.
Yeah.
moderation is the place if youare forcing your kid to go do
your relive your high schoolyears that's wrong we all know
that right we got that but idon't think it's wrong to force
your child to integrate withinthe school system that they're
in because they need thatwhatever that interest is i
don't care just they have tofind an interest right

SPEAKER_01 (35:22):
sure

SPEAKER_00 (35:22):
um so same thing with everything if everything
you do you approach it with justa moderate level head balance
approach um sometimes you'repushing sometimes you're pulling
back it's you know i call it Ihate to say this, but ABA is
good parenting.
You know what I'm trying to say?
It's just good parenting.
You're kind of pulling.
And so sometimes you have tomask.

(35:44):
Other times you need to live andbe in your own truth.
You need to be who you are andpeople need to accept it.
So it's that push back andforth.
And as long as you're doing itin a moderation and you're doing
it, you know, and you're givingyour child the most options, the
most freedoms and the mostchoices, and they're
authentically choosing whatthey're doing, I think you can't
go wrong And I think the samething in ABA therapy.

(36:06):
I mean, once I give a child theskills, if they choose to use
the skills, great.
If they choose not to, that'sokay too.
But at least they now have theability to choose who they want
and what path they want to go.
Without those skills, they can'tchoose that.

SPEAKER_04 (36:19):
That makes sense.
Now, you've mentioned trainingseveral times, which I think
fits right into here in thesense that maybe given the need
and the quick proliferation ofABA and help therapies to
address challenges for autisticindividuals, for example,
therein, we run the risk of notdiversifying our treatment, of

(36:41):
teaching this very linear, atrisk of being too authoritarian,
just do what I do because You'rethe one that's affected, and I'm
the one that knows how to fixyou.
So I can see where we can getinto trouble here.
And I think you're talking aboutthat.
So let's talk about training fora little bit and what else needs
to happen here, knowing thatyou've got a conference coming

(37:01):
up that wants to discuss allthese things.
In your terms, having come backinto the field, knowing that
we're in the middle of it rightnow, and yes, we do see a lot of
problems, where does thetraining fall short?
What are some of the possiblesolutions?

SPEAKER_00 (37:15):
So I think one thing that a lot of young people are
not aware of and have notunderstood about the background
of not just ABA, but hospitals,medical, academics.
And this is the part that Ithink the young people really
don't understand.
Up until the last maybe 15 or 20years, women did not have a

(37:38):
voice in any of this.
And the reason why that's animportant thing to understand
is, and I'm not trying to besexist here, but men generally
are authoritative.
So I want you to think about howacademics were taught.
If you think about in the 30s,40s, 50s, 60s and go through, it
was very teacher standing infront of the room, everyone

(37:58):
would be quiet and everythingwas done.
ABA came out of an authoritativetype of environment, but that
was applied across the board toall environments.
One of the benefits of havingwomen in a field is that we
bring a different perspective.
I have never felt authoritativeat all with ABA, which is why
when I hear the ABA, I'm like, Idon't understand where this is

(38:19):
coming from because it doesn'tresonate with me, which is also
why I think women are more opento that side.
And I think even young men now,but I don't think they get the
fact that I remember being inschool and I remember doing
clinicals.
And I told this when I was in myearly twenties, I was doing a
clinical and I remember thedoctor was older, very well
established.
And he just said, he literallyturned around and looked at all

(38:41):
five of us and said, do notspeak.
do not talk to me.
If you bother me, I will kickyou out and you can start over
in another place.
I literally have you trackingalong.
There's nothing you're going tosay.
There's no question you're goingto ask that's going to be worthy
of my time.
You are nowhere near where I'mat.
Just follow and get your credit.
And that is how he talked.

(39:01):
And nobody, there was no goingto principals or going to
administration.
My high school teacherexplained, who I absolutely
love, by the way, and wrote meone of the best recommendations.
wrote me explaining in class tous why chemically women were not
able to have as clear thoughtsas men because we had different
hormones when i tell that topeople they think i'm crazy

(39:24):
right okay mr martin was he wasthe most loving man you will
ever meet he actually does notbelieve in the route i took with
my life he thought i should havedone a different route but he
wrote me a great letter to go tocollege So I try to explain to
people that this authoritativething doesn't exist anywhere in
our world anymore.
There is, I mean, there's noauthoritative abilities in

(39:46):
schools.
I mean, you go into the schools,it's a free-for-all now.
I mean, actually, I think somepeople would say we kind of need
a little bit more authority,okay?
You go into healthcare.
I mean, you have patients comingin telling doctors after, you
know, doctors have 20 yearsexperience using Google to try
to explain to the doctor whattheir problems are.
And the doctor's going like,okay, I mean, we have broken

(40:07):
down on all that authoritativelines.
I mean, look at politics.
I mean, that all has gone outwith, it's all gone.
I mean, we are now kind of in anew world.
I don't think ABA could ever beauthoritative because I don't
even think families today, theway they parent, the way we
operate, would ever allow thatto happen again.
And I'm saying it should happen,by the way.

(40:28):
I grew up in it.
I can tell you it was not agreat model.

SPEAKER_02 (40:31):
Yeah, I might push back a little bit on that,
though.
I think kind of the idea ofrefrigerator parenting and
blanket extinction and thingslike that did come from.
maybe misapplied ABA.
So not ABA in general.
And maybe that's what you'retrying to say, that training
piece, which is so important.
Because I think a lot of whatyou're saying is we just need

(40:51):
people that know how to do itbetter.
And it goes back to youroriginal point of people coming
out of these graduate programsthinking they know everything
with no experience and thenmisapplying it.
But then at the end of the day,ABA, I mean, that's the whole
point of the BACB, right, is toregulate the practice of ABA.
And it's only going to be asreputable as the people that are

(41:13):
practicing in ABA.
Mike and I, I mean, I rememberone of the people left our
company um we went through alittle bit of a renaissance at
one of our previous companies umand when we told this person hey
you don't necessarily have totake data on every single trial
that occurs because you canstill get an idea and i felt

(41:33):
this person's head was going toexplode and they literally left
the company reported us to theboard and which went nowhere on
like if there's one trial thatoccurs and there's no data
that's taken his mind wouldexplode um so i think a lot of
what you're saying with withrelevant training uh makes sense
but But I would push back thatthe way that, not necessarily
the way that it should be, theway that it has been done

(41:54):
because of the lack of trainingand the lack of oversight has
led to, and we typically useauthoritarian to communicate
what you're saying,authoritative, just so if any of
our listeners come, I think whatshe's talking about is the
authoritarian side of things.
I think it has been kind ofauthoritarian and how it's been
promoted as, if you don't giveme the exact behavior that I'm
looking for, I'm going towithhold your entire

(42:15):
environmental stimuli and you'renot going to get access to
whatever you want.

SPEAKER_04 (42:19):
So it's sort of striking the balance between a
uniformity in terms of anenvironment and then those
exceptions to the rule whichmaybe are managed in a way that
then the uniformity is able toabsorb or maintain.
The idea that there's not thisback and forth shift on the
seesaw that's way too long.
It's okay to have opposingviews.

(42:40):
but the idea that the furtherapart they are, the more
polarized things are, thescarier the seesaw ride is, I
guess.
And thank you for making thatclarification there, Dan, just
because I think that you weremaking a great point.
We often talk about DianaBomren's parenting styles here,
so authoritarian being sort ofthe one that you don't want to
spend too much time on unlessyour kid's running out in the

(43:02):
middle of the street and noisn't enough, and then the
authoritative part being themore collaborative piece.
And I think you make a reallygood point, again, with the idea
of your experience and how avery strict structure, although
it wasn't an ideal situation,and you're glad we've progressed
away from that, however, it didensure that you learned what you
needed to learn.
And if we don't have somesemblance of that, then to your

(43:25):
point, it all starts fallingapart.

SPEAKER_00 (43:28):
Yeah, I do.
And I agree with you.
I would actually love to havesome VC or some AVA people come
out who are actually doing whatyou said, like they flip out
because of the fact that youdidn't take all the data because
you can fix that.
I agree with you.
That you can fix.
Have you seen some of the newstuff that's going on out there?
Like they don't take any data.
Like, they don't do any data.

(43:50):
And the thing about it is, it'sreally interesting that what
I've seen with the training partthat really scares me is, and
you talk about how they thinkthey know, a lot of these young
people know things.
It's like, I can usually walkin, because I've been in and out
of programs, and I was trained alittle bit.
I was trained out of some areas,like in D.C., where there was
lots of different views.
And if I wanted to work, I hadto be able to move among all

(44:11):
these different views.
I can walk in and generally lookat what someone's doing and give
me a couple minutes I can figureout philosophically what they're
talking about or what they'regoing back for right I could go
into these rooms and I wasconsulting I can't do any more
driving nuts but I go in andI'll watch I'm going what are
they doing like what is going onin here and then they say oh
we're doing play therapy and I'mlike play therapy this is not

(44:33):
play therapy I don't know whatthis was but okay and then I
find out the person has you knowthe the BCBA has read a book And
so they now know, or they'redoing RFT because they did Foxy,
was it Foxy Learning?
That made them an expert in RFTnow.
So now they can do RFT.
And I'm like, wow, like that isa problem.

(44:54):
And I think we talked aboutthat, about the authoritative
behaviors that we do and howit's all one mindset.
there's a slight part of me thatwas like, man, I would really
love to have that back and playa little bit because I can
actually move those people intoa more moderate response format.
Kind of like what you guys do.
Like you don't have to take dataon every single stool.

(45:15):
You don't have to do it exactlythis way.
You can moderate it to the childand you can change things and
you can move things around.
I would rather have a startingpoint where everybody was
trained very rigidly and thenmove them that direction, where
today I feel like everybody isbeing trained, it's like a
free-for-all out there, and theythink they know what they know,
but they don't, and trying tobring them back to a more

(45:38):
established method so that youcan kind of move them from that
point forward, I think has beenreally difficult.
I was shocked that most peoplecould not tell me where, like I
said, in the A, B, C, wherewould you create a new behavior?
I mean, I can't tell you howmany of the BCBAs would say to
me, oh, well, we're just goingto reinforce.
And I'm like, reinforcementassumes you have a behavior.

(46:01):
For sure.
Or at least some behavior,right?
What method?
I said, pull up your Cooperbook.
And I actually had a person sayto me, oh, yeah, we didn't use
that Cooper book.
And I'm like, we're just goingto try today.
Pull it out, but let's look atit.
Where do you create a behavior?
Where in your plan do you evenhave a skill or a method of how
you're going to create thisbehavior that is absolutely

(46:25):
mind-boggling that you can getthrough school and now work
independently, creating plans,and you are now a clinical
director at a major company overmultiple BCBAs, and you did not
know the basic five ways tocreate a behavior.

SPEAKER_04 (46:40):
Sure.
The need is at fault for that, Iwould say, right?
A lot of us moving very quickly,and I say us just to be
inclusive.
I'm entering my 28th year ofpractice, so I'm going to say
I've paid my dues.
Mr.
Dan, you had something for us.

SPEAKER_02 (46:53):
Yeah.
I did.
Oh, yeah.
I think you bring up a goodpoint.
And we've actually done episodeson this about collaborative
therapy and about BCBAs kind ofstaying in their lane.
I mean, we are the experts ofbehavior, and that's where data
comes in.
We're not the experts in playtherapy.
We're not the experts in speech.
We're not the experts inoccupational therapy.
We're not experts inrecreational.

(47:13):
So the more we could be almostnot utilized to even suggest any
therapy per se, but to work withthe play therapist or the
recreational therapist andjust...
Take data on what the behaviorsare occurring and say, okay,
well, this is what theantecedents, behaviors, and
consequences that we're noticingwhen you're doing it.
So this is what you can do toincrease or decrease the

(47:34):
behavior rather than suggest anyparticular therapy.
I think you do bring up a reallyinteresting point there.
I will say with the data point.
And one thing that I see a lotfrom the field and I've heard
from I've seen it and I've heardfrom a lot of people who've
reached out to us specificallyrecently is that in theory,
data, data does make a lot ofsense.

(47:55):
But what we're actually seeingin practicality is that these
parents are saying they seetheir supervisor maybe once
every month.
And I mean, this is allviolation of the ethics codes,
but maybe I'm saying what'sactually happening out there in
the field.
And if you're asking an RBT totake data on a five day a week
session and the supervisor isviewing it Maybe once a month.
That data is not being usedanything usefully by the time

(48:19):
that the data is showing atrend.
You're talking about three moreweeks before somebody comes out
there and even does anythingwith it.
So I think in the lab or how itshould be done, sure, then data,
if you're taking regular data,then those modifications can be
done immediately.
But if the supervisor is notbeing out there, which again,

(48:39):
we're hearing is unfortunately,it seems like more of the norm
than the exception to the rule,then that data is kind of going
nowhere and it's just becomingfrivolous.

SPEAKER_04 (48:47):
Data becomes a matter of documentation, a
matter of meeting theregulations.
And I mean, I tend to see my...
clients and my families and myRBTs a lot.
And then when I do take a peekat the data, it makes sense
because I've seen what'shappening in vivo as opposed to
taking a once-a-month snapshot,if it's even once a month, of a
bunch of data points that may ormay not have been collected

(49:10):
effectively, may or may not betied to true SDs or good
incidentals or might not be agood sample of the data.
It could be the RBT just wantsto get their session done, so
they're just here, oh, they didit this many times and this
many.
times we're a minus and yep soon not to mention other things
that we've gotten into like youknow percentage of opportunity
why are we the only onespresenting opportunities doesn't

(49:32):
the rest of the environmentpresent us these we believe it
does or what does that data meanyou know

SPEAKER_02 (49:38):
or with that with what you're saying like if i've
asked this kid 15 times to saytheir name but i haven't gotten
their attention one time but i'msaying this kid doesn't know how
to say their name that's againthat's data points but data on
bad programming is bad data

SPEAKER_04 (49:50):
and then the child tantrums and now they're
tantruming for who knows whatfunction well maybe because they
satiated on you asking them tosay their name.
I don't know.
I might've stopped responding.
Dan, if you sit here and say myname 15 times by the fifth, I'm
probably going to start ignoringyou.
I don't know.
Just a thought.

SPEAKER_00 (50:07):
I agree with you on that context, but I'm going to
try to persuade you in a wholedifferent direction.
And I'm hoping you keep yourminds open and I hope you guys
become big

SPEAKER_01 (50:17):
advocates.

SPEAKER_00 (50:18):
Keep your feet big out.
We need more data to, and moredocumentation and not less.
And I'm gonna tell you why,okay?
Just gonna throw this one toyou.
I was trained in the hospital,so I do data through the
hospital.
So we do every 15 minutes.
And I trained in my company, Idid that.
And because I required that typeof, meticulous work my bcbas

(50:42):
only had five clients and theywere on site with the um bts um
for a whole day so like if wehad a 40-hour thing they had
they did their 40 hours theywere there all day on monday for
example and they were doing andbecause of the way i set up my
notes and everything they weredemonstrating they were so what

(51:03):
i'm seeing is scaring me is thatBecause we all know, because
we're all experienced, the threeof us, we get it.
If you're going in and doing 5%supervision on a case and you're
there once a month, who careswhat the data says?
Because by the time you getthere four weeks ago, that data
doesn't even make sense.
Who cares?
It's a waste of time.
Let's not do it.
But here's the problem.

(51:25):
We are changing the methodologyto fit the problem, not the...
fixing the problem.
And here's what really scaresme, because I'm going to tell
you something that I cameacross, because one of my old
students called me and said,Jen, what do I do?
And then I called Eric over atCASP.
And when I realized there was noreal good options, I was like,
we are in serious trouble inthis situation right now in ABA.

(51:47):
I mean, I thought we were introuble, but now I really think
we're in trouble.
There's a company out therethat's in multiple states right
now that's operating.
It's very big.
And there's many, not a few,many BCBAs on staff working.
And this company does not haveany cases assigned to any BCBAs.

(52:08):
So basically, you give yourhours that you are available to
work.
And then they give you casesthat are available during those
time periods.
So no

SPEAKER_02 (52:16):
continuity.

SPEAKER_00 (52:18):
None.

SPEAKER_02 (52:19):
Okay.

SPEAKER_00 (52:19):
And only one BCBA...
who is on staff, who does noneof the supervision, will alter
the goals

SPEAKER_02 (52:28):
by themselves.
Yeah, we see that,unfortunately.

SPEAKER_01 (52:31):
That

SPEAKER_00 (52:31):
is

SPEAKER_01 (52:31):
crazy.
That's crazy.

SPEAKER_02 (52:34):
Yeah, we see that with some of the hours rat races
and things like that abouttrying to hit billable standards
so you're going out on whoever'scases that you have no idea
about just to hit hours.
I will say with the way thatinsurance or the way the aba is
administered um does create anissue with data taking because

(52:55):
you're having the same personadminister the program and take
the data which can bechallenging because anytime
you're taking data you're notengaging with the person so
potentially in a medical settingmaybe you do something and then
you go and you're away from thatperson for a minute and you can
take your data you're notnecessarily there the whole time
so I think it can be verychallenging the way that the

(53:17):
current ABA therapy isadministered.
Now, if you have a supervisortaking data on an RBT, that's
great.
Or if you're watching thesession afterwards and you can
take data in vivo.
But what we find that in vivohappens a lot if you're asking
the same person to take data andengage the kid is it gets really
herky-jerky and then you loseall of the momentum.
And then the actual thing you'retrying to take data on suffers

(53:38):
because you're just trying toget data.

SPEAKER_00 (53:41):
I'm going to push back just a little bit on this
one.
I'm going to try to say look atit from a different perspective
because this is how I trained mystaff and I trained my DCVs and
everything to do is that younotice how like we went from
being very unstructured when wewere parented kids and then we
went to like now kids are likeare literally booked from
morning to night and it's verystructured.
So one of the things about ABAthat if you do highly structured

(54:05):
something highly structured andthen you go to you need to give
them unstructured time.
Kids need to play.
They need to have they need tohave moments of unstructured
time and they need to developindependence and all stuff.
So one of the things that Ithink data collection does, it's
a built-in system.
It forces the BT and the BCBA toplan in their sessions, okay,

(54:26):
I'm going to do these threethings with the child.
Now, the child's going to haveto be alone for about, you know,
five, 10, 15 minutes, whateverit is, so that I can put this
stuff together, get the nextsystem set up.
I can take data.
What can I do?
that effectively has this childengaged allows them to do it and
and not become I can't have himrunning around the house crazy

(54:47):
making craziness how do I do itit forces them to help the child
learn how to be independentbecause one of the things that
most of the parents that Iworked with who had young
children would say was thebiggest change in the first six
weeks of their of their lives isthat our family functions better
is because for the first timetheir child now is able to
engage in independent activitiesthat are engaging even at four

(55:10):
three four and five years old itforces the to deal with that
particular issue.
It forces them to deal withself-regulation because if the
three-year-old just startsscreaming, yelling, and going
crazy in the house or goes andstarts knocking on windows,
there's no self-regulation.
So I would say that having thatbuilt-in forces, one, it gives

(55:32):
you good information.
It gives BT time to reset sothat they're not overloaded.
They're not just going boom,boom, boom, boom.
It gives them a chance to readthe programming.
It gives them a chance to kindof get themselves in play so
that they give really effectivetreatment.
It allows them to take thesession notes and make comments
and say, hey, you know what, wereally had a rough morning.
I think this activity is causingsome issues, a way to

(55:53):
communicate with their BCBA.
And it gives and it forceseveryone involved to help that
child learn to self-regulate, toself-entertain and self-motivate
themselves in an independentactivity.
So I think data collection isessential.
And one of the reasons why Iwrote my books, you know, my
textbooks are all about datacollection because I think that

(56:15):
it's like one of those missingpieces of the pie that we have
moved because of funder issuesbecause of poor training from
the BCBAs and from the schoolsand because we see it as a way
to meet the big brother You knowwhat I'm trying to say?
We've missed what really, andlike I said, I was trained in
hospitals and I see howhospitals use data.

(56:36):
And that's probably why I seedata that way.
But that's my only pushback onthat one.
I think data can be a goodthing.

SPEAKER_04 (56:41):
So we don't disagree.
We like the data.
I think that we're coming fromthe angle of that was posited
first.
So the idea was, I like to usethe example of an ABA, at least
in the old days, we oftenplanted a seed and watered, and
we'd sit there measuring.
And there was no sprout.
What the hell are we measuring?

(57:02):
But now I say, hey, once you seea sprout, go teach, go teach, go
teach.
You see a sprout, go measure thesprout.
And so I think we agree on thedata part.
We're coming from the angle ofdata was way too intensive.
And initially we were trying torecreate the whole session with
every singular data point, whichI like to say, if you're
texting, who's driving?

(57:23):
If you're taking data, who'sintervening?
Nobody, you're taking data.
So I think that's what Dan wasreferring to with herky-jerky,
the idea that you're going backand forth, back and forth,
versus the notion of momentarytime sampling, right?
Something like that.
So we agree on the data.
The data is important.
This is kind of like what yourconference is gonna do.
We're coming from two differentsides of it, but we compromise
in the middle.
Data is important.

(57:44):
Mr.
Dan,

SPEAKER_02 (57:45):
take this away.
I was just gonna say, I totallyagree with what you're saying,
and independent leisure skillsare very, very important.
I think one thing that you runinto, though, with the way that
maybe you're talking about orthe older school way that ABA
was administered is the personis there administering the
structured time, and thenunstructured time basically
independent time so thereforethe rbt now becomes a condition

(58:06):
adversive because the only timethat they're there is they're
running the structured programand breaks mean you're away from
me so i'm not really thereduring the fun time so i think
we try to integrate thestructured time is more like
within the routines that they'rehaving because a lot of the kids
we work with get plenty ofstructured time at school so for
us to come into your home andsay not only a structured time

(58:27):
at school but now home isstructured time can be
challenging to then take data incongruence with how we're
administering the program.

SPEAKER_00 (58:36):
No, I agree with that.
And I think that that makessense.
But I will say this.
I'll go back one step.
Sure.
Is if you do 45 minutes ofstructured time, structured time
should be incorporating thatplay and social skills.
Sure.
So you should be doing that.
When I talk about structuredtime, it's like I'm
incorporating anything thatyou're doing where you're

(58:56):
actually putting an interventionin place that you're actually
incorporating you're directlyinvolved in whereas I do think
kids because I mean I'll behonest with you if I'm with
adults all day and I have to sitand talk to someone for you know
hours on end I need to go get acoffee like I go I go to the
bathroom that's my way ofescaping and finding a way to
have 10 minutes down or 15minutes down and I do think that

(59:16):
in an hour time frame giving akid 15 minutes to have downtime
and do something that'sself-regulating self-structured
is it was good in my opinion inthat sense but I do agree with
you if you're doing verystructured activities like DDT
for 45 minutes and then you givethem 15 minute break without
question, the adversity is goingto come.
They're going to say, oh, the BTis an adversive type of a

(59:37):
situation.
But I would venture to guessthat they should do 15 minutes
of DDT, probably 15 minutes ofsocial play and interactioning,
and then 15 minutes of some typeof communicative interaction,
maybe with the family members,interaction within the home so
that the family is being, theirneeds are being met also.
And then 15 minutes for the kidto kind of like ignore you.

SPEAKER_04 (59:58):
That's the negative reinforcement.
reinforcement time, right?
That's my girlfriend's favorite15 minutes of the day.
Negative reinforcement, get offmy back, basically.
I like the way you put it.
I think we're talking, again, Ithink we're talking about the
same thing from two differentsides.
One thing I love talking about,just given my developmental
background, is the idea ofchild-directed, especially for
early intervention, the idea ofchild-directed intervention,

(01:00:19):
right?
So when I tell people aboutthat, they're like, oh, so you
just let them do whatever theywant?
I'm like, not exactly.
Well, we need to have structure.
And usually when people saystructure, what they mean is
adult-directed It means I'vepicked the materials, I've
picked the time, I've picked howlong we're going to do it, and
it doesn't matter what you saybecause the moment you cry about
it, now you're protesting asopposed to communicating, hey,

(01:00:40):
man, you're not giving me enoughof a chance to do this myself.
So...
I think you're absolutely right.
I appreciate what you're sayingin terms of that balance and
that dance from, hey, I've gotthe structure.
I've got a plan.
I think I know what materials wecan use to teach you toward the
achievement of these goals.
And then all of a sudden theincidentals occur and kids do
what they do, which is derailyou.

(01:01:02):
And now the experience and yourtraining now prepares you to
turn anything that they'reinterested in just about within
reason Now back to your goals.
And I think that's the hardestthing that I, at least in my
career, the biggest challengeI've faced is trying to explain
that to people and saying, hey,I'm not saying don't plan, even
though I can sort of tell thatafter 28 years, I can kind of

(01:01:24):
walk in unprepared knowing thatkids have toys.
We know what we're talkingabout.
Again, I feel comfortable, butit's taken me a long time to do
so.
And I'm trained in thatdiscipline.
I come from a child directeddevelopmental early childhood
best practices kind ofbackground too.
So it's been a great analog tomy ABA and hence my position
right now.
I'm kind of, okay, ABA might bea too authoritarian.

(01:01:46):
Well, that's not fair to ABA.
I think I'm talking about theway certain practitioners
implement it.
Now, this has been a perfectbalance here.
I think this really harkens towhat you're trying to do with
your conference.
Dan, did you have anything forus before I...
We're at the hour mark, so wedon't have to rush off.
We're having a greatconversation, but we do like to
keep it in nice, digestiblechunks of about 60 minutes.

(01:02:06):
Again, Jennifer, I have no doubtthat whether before October or
after October, you're going tobe back on the ABA on tap, so
we're very glad to have you heretoday.
Mr.
Dan, did you have something forus today?

SPEAKER_02 (01:02:16):
I did.
I had one more question, and Ialso wanted to open it up to you
afterwards to speak about yourconference and mention anything
that you wanted.
So what we were talking aboutearlier, we kind of went down on
some tangents about kind of the,and I agree with you about when
you were talking about socialinteraction and the importance
and things like that and evensome of the comparisons that
were made there were prettysignificant.

(01:02:40):
What are your thoughts on ABAkind of like the end justifies
the means or even affirming theconsequence, saying that because
whether it's social interactionor whatever it is We were
talking about the catheterexample.
Because it's so important, thenpeople kind of have carte
blanche to do whatever they wantto get it there because of the

(01:03:01):
importance that we put on it.
What are your thoughts onaffirming the consequent with
ABA?
That's my last question, andthank you.
I'm interested to get yourperspective on it.

SPEAKER_00 (01:03:08):
I'm probably going to fall again in the same way.
I'm probably going to triggersome people.
So I'm going to try to be, but Iam very much an environmentalist
and I am completely freaked outthat if by 2030 we don't cut
commissions by half, we're goingto be in serious trouble.
So I'm at the point where I'mlike, the ends will justify the

(01:03:28):
means here at this point.
Whatever we have to do, we haveto do this, right?
That's kind of where I'm at.
And that means a lot of peopleare going to get hurt in order
to make the change that we haveto make from point A to point B
in order to save our environmentand save our planet, right?
So when I say that about, aboutpractitioners in the field,
there's also a secondary levelhere that I realize and I have

(01:03:51):
been brought to my attention onthis level because I have worked
with some younger people who arenow doing stuff with me who have
had years in experience and oneof them was Elizabeth and she
said to me, Jen, you have a veryclose, very tight knit group of
people that you have been aroundthat you don't see what's really
happening out there.
So it says you have this faithin people.

(01:04:12):
You have this belief that peopleare always going to err on the
right side you just do becauseand you have and they all have
competence so you know they'renot going to make these bad
decisions so this is allhypothetical to you but I
actually work in the field and Isee where people are making some
really bad decisions and we'reseeing some really bad things
and she's like I worked with youJen she goes all the things that

(01:04:33):
you do with Ascent and all thosethings that they're out there
compassionate care traumainformed she goes you do it all
the day in all of your ways youdo it naturally you don't even
realize what you're doing shegoes you do it better than the
people who have levels bycertification, you know?
And she said, so she says, youjust don't understand what's
happening.
And so that is what scares me.

(01:04:54):
And that's why for the firsttime in my life, I'm going to
show some hesitation herebecause if you ask me,
absolutely ends justify themeans because there's never
going to be a time where I'mgoing to do something that is
going to cross that line.
That's going to be a problemwhere the ends would not justify
the means.

SPEAKER_01 (01:05:10):
Gotcha.

SPEAKER_00 (01:05:11):
I do not know with the level of training and what
is happening.
And after finding out what isgoing on with like BCBA is
thinking it's okay to not havecases and that they just pop on
to get their hours in to getpaid.
That's okay with them.
That does bother me.
That makes me nervous and makesme say we have a problem.

(01:05:31):
So yes, at this point in thegame, no.
Be very clear that I would notput my, I never hired someone
and never had anyone work for mycompany that I would not be
willing to put my daughter with.
And I can tell you right now,75% of ABA out there, there'd be
no way I would put my child withthem.
So that's what I think about ABAat this point in some ways,

(01:05:52):
okay?
So I understand parents.
I absolutely understand whereparents are right now.
If I were a parent, I'd bescared.
That's partially why at theconference, we've all opened
this up to parents and we wantparents to hear all the
conversations because that willhelp them have a better judgment
of what they're seeing in frontof them.
Because I will say, I do think75%, and some people say that's

(01:06:13):
high.
I don't think it's high.
75% ABA therapy out there rightnow would not be therapy that I
would put my own child in.

SPEAKER_02 (01:06:20):
Gotcha.
So what you're saying, just tomake sure that I understand, is
that it does, but with propertraining.
And the current ABA is lacking alot of proper training.
Is that- Am I understanding

SPEAKER_00 (01:06:29):
that correctly?
Okay.
You're a skilled expert.
I think you can have a lot ofleeway because you're going to
balance those pros and cons verywell and you understand them.
I think probably 70, 80% of theBCBAs out there do not have the
experience to be making thosekinds of decisions.
And if I were a parent, Iwouldn't be giving that kind of
decision making to them.

SPEAKER_04 (01:06:47):
Absolutely not.
We hear that they're 75 to 80%aren't showing up more than once
a month.
Anyway, so I don't know wherethat leaves us, but that was my
last question.
Last question.
Uh, Jennifer, why don't you leadus out here by telling us all
about the conference once again,some of the presenters that are
going to be there.
Just give everybody all the infoout there before we wrap up

(01:07:09):
here.

SPEAKER_00 (01:07:11):
So, yeah, CPABA is really a different conference.
It's not meant to come.
It's supposed to help if you area new BCBA or if you are a
student BCBA or if you are inyour career by three or four
years.
The topics are going to bediscussed in a really big
spectrum.
So you're going to have the mostextreme on one side to the other
side, and then you're going tohave everything in between.

(01:07:31):
And it's not just in theory.
It's going to be this is howwe've applied it.
One of the doctors is not even aspecialist in one of the fields,
and she's going to be talkingabout on one of the panels how
she tried to implement a programinto her clinic and couldn't do
it.
And here's all the reasons why.
Here's all the problems.
So that if you're trying to dosomething and you have these

(01:07:52):
same circumstances, of times isit might not work for you.
It's trying to help prevent usfrom implementing things
incorrectly.
It's trying to help us implementthings correctly because other
people are going to provide youwith the training materials for
your RBTs.
They're going to provide youwith how they implement it.
So the discussion is about howas a BCBA or an owner of a
company or a clinical director,how do you implement this?

(01:08:14):
On the backside of this is forparents.
And it's like we're trying toinvite parents and say, like,
you have a BCBA is telling youthis what we should do are you
aware that there might be eightdifferent ways that you could be
doing this and the way they'redoing it is because they either
that's the only way they know orthat's the way that they feel
that they can do it or that'sthe way their company does it
did you know there's other sevenways you could do it and yes you

(01:08:37):
could find a bcba or you couldtry to force this issue to get
it this other way because theother thing that's really
problematic is if you're doingsomething that doesn't fit the
dynamics of that family or theculture or whatever it is in
that family you're not helpingthe family And that's the other
part of it.
So we're trying to approach itfrom two different ways to bring
accountability back into thesystem.
And we're trying to help BCBAswho are on the ground, who

(01:09:00):
actually have to implement thestuff, who don't know how to
implement it because they'venever seen it done because
either they didn't have thementoring or their company
doesn't do it or they've neverbeen exposed to it, or they have
to modify it in a way that isnot being represented in the
research because of theparameters or the barriers that
they're dealing with on theground.
And that's what this is about.
So I hope we get lots of people.

(01:09:20):
We're hoping that we get lots ofBC CBAs and we're hoping we get
lots of parents to try to helpchange the dynamics of ABA.
So

SPEAKER_04 (01:09:29):
just punch in CPABA to your Google search.
It should come right up.
The dates for the conference?

SPEAKER_00 (01:09:34):
It should come up on it.
Behavioral Live, by the way, ishosting it.
For those who know, go toBehavioral Live.
You can see it there.
It's virtually, it's on the 11thand the 12th.
Of October.

SPEAKER_04 (01:09:43):
11th to 12th

SPEAKER_00 (01:09:45):
of October.
It's Friday and Saturday.
And like I said, the conference,when you go on there, we're also
offering really unique stufflike We have sex education for
four hours where we have some ofthe best sex professors in the
area.
We're going to talk about how todo this so you don't cause
problems.
We have feeding experts who aresaying, here's how you can
implement this program into itso you can be educated.

SPEAKER_01 (01:10:04):
That's so needed.

SPEAKER_00 (01:10:05):
Yes, it's absolutely needed because the doctor will
say, we're actually doing moreharm than we are helping because
of how we're dealing with thisstuff.
So we have sleeping specialists.
So we're trying to also bring inareas where if you are out there
practicing sex, how do youpractice in these areas where
these things have to be dealtwith and you might have not
gotten mentoring.
So this is another, we're alsobringing in, and again, it's not

(01:10:26):
in theory.
It is, here's how you do ithere.
I'm going to give you thepaperwork.
I'm going to give you thetemplates.
I'm going to give you theworksheets.
I'm going to give you locations.
I'm going to give you the books.
So it's, again, it's a way toactually take it from, from the
conference right into practice.

SPEAKER_02 (01:10:40):
So is this, um, directly for BCBAs?
Is it for RBTs?
Is it for parents?
Who's the audience here?

SPEAKER_00 (01:10:46):
It's for, truthfully, our goal is to try
to, and that's why we havedifferent price points to let
people in.
We're trying to get everyone tocome in because I think if
everybody's informed about this,then we start having an
accountability system in place.
Okay.
Because if parents understandhow a feeding program works and
they're seeing it differentlybecause someone's doing it, if
an RBT is being told and onlyseeing their BCBA once every

(01:11:07):
month, but they actually come inthe conference and they can see
how something's done and theysee there's other methods that
they could be using, they canput pressure on the BCBA to
start putting them.
Sure.
The CBA is an organization andthey're seeing, wait a minute,
every doctor on that panel says,this is what I should be doing
at one way or another in thisformat, but we're doing it this
way.
They can start pushing backagainst the owners and pushing

(01:11:28):
back against their clinicaldirectors and the funders.
So the goal is, is that ifeverybody sees what truly exists
and how it works in clinicalpractice, then that information
can then help push back againstsome of these really poor
practices.
For example, maybe you shouldn'tbe doing 5% supervision.
At minimum, you should be doing20%.
So

SPEAKER_02 (01:11:49):
it's for everyone.
It's for RBTs, BCBAs, parents.
And then one more time, justwhere can they find it and what
are the dates just so thatdoesn't get lost again?

SPEAKER_00 (01:11:57):
It's October 11th and the 12th.
It's on Behavioral Live website.
You can go there or you can goto CPABA Conference.
I found out a while back thatthere's a company called CPA.
So you must be in conference.
I did not know that.
There are no association to us,by the way, but Behavioral Live
has it.
And also it is, you can go CPABAConference, Clinical Practice

(01:12:20):
Applied Behavior Analysis.

SPEAKER_04 (01:12:21):
All right.
I'm going to take us out here.
Before I do, I do have toclarify something because we
referred to the once a monthsupervisor Now, If that
represents your 25% supervision,that's okay.
I think we were finding thatthere were supervisors who, you
know, kiddos were getting eight,ten hours a week, and then
they're only being seen once amonth.
If you're doing that, pleasechange your ways.

(01:12:43):
Get out there at least 20%.
Even some insurance providerswith their stringency will keep
you at 20%, so that's a goodcompromise there.
Jennifer, it's been a pleasure.
Thank you.
I know you're going to be back.
We can't wait to be part of theconference and check out what
you guys are talking about.
We'd like to wind down with afew recommendations here.

(01:13:03):
So I believe you're saying staytraining and learning, stay
radical, and like we'd like tosay at the end here, always
analyze responsibly.
Cheers, Jennifer.
Cheers.
Cheers, Dan.

SPEAKER_00 (01:13:15):
Thank you.

SPEAKER_04 (01:13:16):
Thank you.

SPEAKER_03 (01:13:17):
ABA on Tap is recorded live and unfiltered.
We're done for today.
You don't have to go home, butyou can't stay here.
See you next time.

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Clinical Practice in Applied Behavior Analysis--Special Guest Jennifer Fitzpatrick, CPABA Conference

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

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