June 15, 2025 • 51 mins
ABA on Tap is so proud to spend some time with the illustrious Portia James. (Part 1 of 2)
As a visionary, a powerhouse of a leader, and a pioneer for women and people of color in her field, Portia James has been shaking conference room tables for nearly two decades. She shares bold perspectives on the lack of representation for black leadership in the workplace and how it impacts decision-making and strategic execution at the executive level. She is one of few Behavior Analysts to have been featured in both Forbes and Harvard Business Review.
Portia is a sought-after Board Certified Behavior Analyst and Organizational Behavior Management specialist who helps black Behavior Analysts launch and scale companies that thrive. As the founder and CEO of Behavior Genius, she has served hundreds of staff and families impacted by Autism.
Portia is a wife to an MMA fighter (of course she is!) and mother of 3 dynamic children, a travel junkie, and a red wine enthusiast. Portia serves up a flight of bold and complex flavors. Sip this one slowly and carefully. Don't forget to swirl, take in the bouquet, and always analyze responsibly.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:00):
Welcome to ABA on Tap, where our goal is to find
(00:14):
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
look back into the ingredientsto form the best concoction of
ABA on tap.
In this podcast, we will talkabout the history of the ABA
(00:35):
brew, how much to consume toachieve the optimum buzz while
not getting too drunk, and therecommended pairings to bring to
the table.
So without further ado, sitback, relax, and always analyze
responsibly.
Thank you.
SPEAKER_04 (00:54):
All right, all right.
Welcome back to yet anotherinstallment of ABA on Tap.
I am your ever-grateful co-host,Mike Rubio, along with Mr.
Daniel Lowry.
Mr.
Dan, it's a Friday, sir.
That's unusual for us.
It's great to see you.
We're here on a Friday.
Clearly, we've got somethingspecial.
SPEAKER_02 (01:14):
I'm super excited to be here on a Friday, on a lunch
break in between your clientswhile you've been able to
accommodate because we were soexcited to have Portia on.
So yeah, changing the Sundayvibes for the Friday vibes.
So the weekend is about to beupon us.
SPEAKER_04 (01:28):
Now, I heard our guest today, our guest Portia
James, might be talking to usabout systemic variables and
burnout in our industry.
And as you said, I'm literallyon a lunch break between
clients.
We're very proud business ownersof a new ABA venture, medical
services, autism treatment.
So this is just the name of thegame.
(01:50):
And this was scheduled waybefore we had new clients and
new employees to support.
So I'm very glad to be here on alunch break.
Very excited.
So without further ado, Ourguest, Portia James.
Hey, hey.
Hey,
SPEAKER_00 (02:10):
hey.
UNKNOWN (02:10):
Come on over.
SPEAKER_04 (02:10):
All right.
Portia, how are you doing?
We're so grateful for your time.
You might be on your lunchbreak.
How are you doing today?
SPEAKER_01 (02:17):
I am on my lunch break.
There's no lunch on my deskbecause my husband is gone for
the day, but I'm doing well.
I'm grateful to be here.
I'm really
SPEAKER_04 (02:27):
excited.
Thank you so much for your time.
We know you keep very busy.
You've got some very importantthings to share with us today.
We're very happy to talk topeople who are not directly
necessarily working maybe onautism intervention services,
but have taken a broader scope,which I think is very important
to the growth of our field.
I think you've got a lot ofthings to share with us about
(02:48):
that today.
We love to start with the originstory.
Tell us how you got started inABA, what other things are part
of your background, what keepsyou driven, family, anything
that you want people to know outthere.
Give us the origin story,Portia.
SPEAKER_01 (03:07):
Yeah, absolutely.
Oh gosh, where do I start?
So I have been in ABA for almost20 years.
Actually, I'll be at 19 yearsthis June 3rd since I started in
ABA.
Congratulations.
Shout
SPEAKER_02 (03:22):
out to you.
Oh,
SPEAKER_01 (03:23):
thank you.
I'll be doing a big, I'll bedoing a world tour next year.
SPEAKER_02 (03:28):
The 20th anniversary.
SPEAKER_04 (03:29):
We better get noticed.
I want a shirt.
I want
SPEAKER_01 (03:32):
a shirt for sure.
I'll have t-shirts.
I'll have CD covers.
A hat.
All of that.
Okay, perfect.
So I started as a behaviortechnician during my
undergraduate internship, and Ijust have kind of throughout the
years worked my way up.
In Southern California, we havethe mid-tier for most of our
insurance companies.
(03:52):
I work with a lot of Medi-Cal,Medicaid clients.
And so I had the mid-tier.
I then got my BCBA in 2011.
And so excited to continue, Ithink, in work that I loved back
then when I was in home.
And I never imagined that Iwould love that.
(04:13):
not being with my kids or notbeing with my uh family but over
the years i just kind of liketook the slow road and i grew
and i had a lot of differentopportunities to practice
teaching the principles ofbehavior analysis, not only to
people that I managed andmentored, but also to families.
And so I've had some prettyinteresting opportunities to
(04:36):
train the San Bernardino CountySheriff's Department graduating
class in behavioral strategiesand recognizing signs of autism,
and how those differ from like,you know, signs of, you other
distress, mental illness andthings like that.
I had the opportunity to teachparent training for the Inland
Regional Center.
I served for a little while asthe behavior consultant for
(04:58):
Pomona Unified School District.
So I got to go in and do all oftheir teacher in-service days.
My master's is actually inteaching.
So at that time, I was using mymaster's to teach teachers how
to set up their classrooms sothat they could be effective
with kids with autism.
That was a really fun So for me,I think just throughout the
(05:20):
years, what I've enjoyed most isbeing able to expand upon just
general ABA in-home services.
I do have three children.
I should mention them.
I've been married for nine yearsthis summer, and I do have three
children.
They are typically developingchildren, ages 16, 10, and 6.
(05:42):
So they keep me very busy.
I'm a homeschool mom as well.
Wow.
SPEAKER_02 (05:47):
well thank you for giving us some time man
SPEAKER_01 (05:51):
this
SPEAKER_04 (05:53):
is an extended recess is that what's going on
here
SPEAKER_01 (05:56):
yeah this is actually it's Friday Fridays are
fun Fridays yeah my husbandtrains Jiu Jitsu he is working
on his black belt but he has acouple fighters that he manages
and so it's fight weekend and somy kids are gone and my husband
just left so that they can go dowhat they need to do to get
(06:16):
ready for fight weekend Verydifferent life than the NBA
life.
SPEAKER_00 (06:20):
Wow.
SPEAKER_02 (06:21):
Wow.
Yeah, I'm a huge UFC fan, so Ilove the jiu-jitsu stuff.
Yes, big UFC fans.
My kids, too.
SPEAKER_04 (06:28):
I catch it here and there.
I catch it here and there.
That's a very dynamic family youjust described.
Congratulations.
Three great kids.
Nice working on the extendedprolonged marriage.
That's an incredible thing,especially these days.
You say typically developing,and I think that's a really...
poignant statement to make,especially when we're talking
(06:48):
about, say, autism services orABA services for autism
intervention.
How would you differentiatebeing a parent, not that either
of us would know being a parentof a neurodivergent child, for
example, but you made animportant differentiation there.
Tell us about it.
What do you think the differenceis in what you do and what a
(07:10):
parent with an autistic childmight be doing?
And then where are thecommonalities, perhaps?
SPEAKER_01 (07:16):
Yeah, I mean, I think parenting is hard.
Common parenting is challenging.
SPEAKER_00 (07:22):
It
SPEAKER_01 (07:22):
challenges, it grows us.
But I've been in human analysislonger than I've been a mom.
And so I'm always really carefulto make sure that I'm clear with
respect and honor to parents whodo parent children who have
special needs or areneurodiverse.
I think it's important torecognize the things that we
(07:46):
take for granted as parents, thelittle things that we get access
to, the experiences that we getto have, the conversations that
we get to have with our kids,even the things that agitate us,
right?
Like arguing back with them.
But getting to do that, right?
And I've worked with so manykids who either didn't have
language or, you know, we're notable, we're teaching
(08:09):
negotiating, right?
We're teaching how to answer aquestion about how school was
today.
My kids, they were able to pickup developmental milestones just
by being with other kids.
And even though there's researchthat suggests that when you put
any kid, a neurodiverse child aswell, with a, another child peer
(08:33):
mediated learning is so robust.
Um, however, the rate, the paceat learning, right?
So there's things that my kidsjust kind of picked up and I was
like, who taught you how toread?
Um, that the kids that I, thatI've historically worked with,
we've had, I, I, I know what itwas like spending six months or
a year, 18 months pottytraining, a child working the
parent through the things that,you know, just, I had parents
(08:56):
that would say, Oh, if I couldwave a magic wand, I would just
want my child to be able to tellme if they got hurt today at
school or if their stomach hurtsor, you know, things like that.
And so I always want to makesure that, that I do, I get
asked a lot.
Do you have children on thespectrum?
And I do not have children onthe spectrum.
My kids are very different.
(09:17):
Their, their needs aredifferent.
Their demands are different.
But I do recognize howprivileged I am to have children
that are, I don't have to stepout of the average typical
difficulties of parenting inorder to parent my child.
We don't have three or fourdifferent types of therapies.
(09:38):
I'm not fighting the schooldistrict.
And so I think that those thingsneed to be acknowledged because
parenting is generally hard.
But when you add the layers andlayers of life that most of my
parents have had to add, itbecomes, I just told you about
the dynamic, like nature of mylife.
(09:59):
Now, imagine if I had a childwho had speech and occupational
therapy and IEP meetings and,and also just wasn't able to
maybe go with the flow of theway that we have a very loose,
loose life schedule.
Um, we don't have very strictadherence to really any routine.
Yeah.
So we have fun Friday that iswithin our routine, but yeah, I
(10:20):
just, I acknowledge thatbecause, um, I think that when
we're talking about ABA andautism, it's also important to
acknowledge that I do have threechildren and as much work as it
is, it will never even hold acandle to some of the
experiences that I've seen myfamilies have to add to their
agendas, but also the thingsthat they miss out on, the
(10:44):
normal going out to dinner, thegoing to the grocery store,
being with family at parties,having a babysitter so they can
go to date night, things likethat, that our parents, the
parents that I've served havejust really missed because they
have been caring for their childin ways that most of us really
could never imagine.
SPEAKER_04 (11:03):
Thank you for that perspective.
I think you You hit a lot ofimportant pieces that really
could guide us as serviceproviders in terms of what
things we recommend.
What are we suggesting theparents are doing to actually
address some of the challenges,behaviorally or otherwise?
Sometimes we can load up thatplate a lot more than it needs
(11:24):
to be loaded up, and I thinkthat teaches us a lot about how
to be mindful.
I know I've said it.
a million times, so to speak,here on the podcast.
But to your point, Portia, theidea that I've got three
children myself.
I've got two teenagers and thena younger four-year-old.
And every time
SPEAKER_01 (11:42):
I...
That's not starting over.
Yeah, yes,
SPEAKER_04 (11:44):
exactly, exactly.
Now I have to practice what hereaches.
Glutton for punishment.
I think she was for trainingpurposes, right?
I was starting a business, earlystart, intervention.
She has to train me.
But I like to say that withevery one of my children, I get
1,000% better at what I doprofessionally because I gain a
whole new perspective now andhaving two children and
(12:05):
understanding what that balanceis and then now the third
children certain age discrepancyand then to your point most
importantly adding all theselayers of intervention the
stress of now discussing an IEPas much as it's a useful service
it comes with a lot of work so Ithink that's a really important
perspective that you you lent tous there thank you so much
SPEAKER_02 (12:25):
Yeah.
You mentioned that you've done,you did parent training for the
regional center out in Pomona.
Was that correct?
The Pomona Regional Center?
SPEAKER_01 (12:33):
It was the Inland Regional Center.
So they're located in SanBernardino.
SPEAKER_02 (12:38):
San Bernardino for the regional center.
But before that, you worked withlaw enforcement, right?
The San Bernardino Sheriffs?
SPEAKER_01 (12:45):
I did.
I didn't work with them.
I actually just had anopportunity from a parent who
was going through the graduatingclass.
She had a child with autism andshe said, you need to come and
speak to them because there wasa child who was killed and by
the police, not in SanBernardino, but in another
state.
She heard about it and she said,this could be my child.
(13:06):
This could be any of our kids.
And there is no the trainingthat we that we are required to
do is not sufficient.
Will you come and speak to mygraduating class?
And so, of course, of course, Iwas open to that.
SPEAKER_02 (13:20):
There was just an individual that made the
national maybe in Boise orsomething that individual with
special needs that got killed bythe.
Police, like a month ago orsomething, made national news.
And again, it's not cut and dry,but that's certainly a need.
In San Diego, we have the PERTteam.
I think it's the PsychiatricEmergency Response Team.
(13:45):
There you go.
SPEAKER_04 (13:46):
Is that just particular to San Diego County?
SPEAKER_02 (13:48):
No, I think, but I know we have that in San Diego
County.
So can you talk a little bitabout your experience in talking
with these individuals?
Did you find that they werereceptive?
And the reason I ask is I workfor a company also called
Proact.
Are you familiar with Proact?
SPEAKER_01 (14:03):
Yeah, I am.
SPEAKER_02 (14:03):
Okay.
So I worked for a company calledProact and, you know, we teach a
lot of de-escalation and crisismanagement strategies.
And we don't train a whole lotof current law enforcement, but
a lot of ex-law enforcement.
And the ways that they go aboutthings sometimes isn't the ways
that we would teach going aboutthings, about maybe client
empowerment and offeringalternatives and things like
(14:25):
that.
So can you speak to maybe thatexperience?
Because I'm really interested tohear your experience with law
enforcement, how they werereceptive, what you said.
Can you take us in thatconference room?
SPEAKER_01 (14:36):
Sure.
It was very eye-opening.
I don't have good news toreport.
It was eye-opening for mebecause I was younger.
This is a really long time ago.
Maybe 15 years.
Maybe 12 to 15 years ago.
And I went in, I am a verypositive person.
(15:03):
We gather that
SPEAKER_04 (15:06):
immediately.
We appreciate it.
Thank you.
SPEAKER_01 (15:08):
Thank you.
I try to stay on the up and up,you know?
So I went in, I have my littlepresentation and I was just
like, I'm going to change theirperspectives.
It's going to be so beautiful.
We're going to come together.
We're going to do a handshakeand everybody's going to think
kumbaya.
And it was tough.
It was really tough because theywere engaged.
They were engaged.
(15:29):
I spoke to them about how toidentify some of the
differences, behaviors that theymay see.
So, for example, they need toknow if a person is nonverbal,
they may not be ignoring them orhow a person with autism may
respond to being afraid.
Right.
So aggression, even aggressivebehavior could be fear.
(15:50):
Right.
And how that might talk themthrough, like how that might
look different thanschizophrenia or, you know, if
they were to find someone, howthey can get informed, who
should probably be with thatperson.
If a parent calls them, thetypes of questions that they
should ask before they go out orwhen they get there.
(16:11):
Just how to assess the situationa little bit better is what I
really wanted.
There's not much I could do inlike a two to three hour
presentation.
But it was really interestingbecause there were some, and
maybe it was that the officerswho may have had children with
autism or no children withautism that seemed really
appreciative that were like,yes, this changes me forever.
(16:33):
I would say out of about 50 ofthem, there may have been two or
three that were like, I'mforever changed.
Thank you for sharing this.
I will be more mindful.
Um, during my presentation, Ishared an example of a child who
was shot, um, he was chasing hismom around the kitchen Island
(16:53):
with a knife over a butterknife, a butter knife over a bag
of Skittles.
Um, and he was denied access tothis candy and it made national
news and I had heard about it.
So I was like, perfect.
I'm going to use this as anexample.
Um, because you know, lawenforcement really wants us to
(17:13):
know what, that their job, Ithink what I learned is that
their job is to eliminate risk.
However, because of what theydo, their perception of risk is
much higher than ours.
Now you would think like in somesituations, like my husband,
he's a fighter, right?
So he goes into the cage and hedoes mixed martial arts.
(17:35):
And so for him, the perceptionof danger is is he has a higher
threshold because he has beenpunched in the face on purpose
for fun, right?
So for him, he's like, I know itsounds scary to you guys, but
for me, once you've done it acouple of times, it's just not
that big
SPEAKER_00 (17:50):
a deal.
SPEAKER_01 (17:51):
For police officers, I almost feel like they have
this response.
They're trained to see danger ineveryday things, which is
something that we canunderstand,
SPEAKER_00 (18:02):
right?
SPEAKER_01 (18:03):
And so- it almost feels like their threshold for
danger is even lower.
And so I learned a couple ofthings.
Number one, they're not trained.
And my husband always says, whydon't they just learn how to
fight?
Yeah.
Yeah.
Why shouldn't they all have totake my martial arts class?
But I learned that number one, alot of them, and they all agreed
(18:27):
with each other at the end ofthe day, I will go out and
protect and serve, but mymission is to make it home.
At the end of the night, I'mfirst, right?
Like whatever.
And I would rather accidentallypull the trigger than to not
make it home, than to be tooslow and not to make it home
(18:49):
tonight to my own family and mywife.
And so there's that.
And then they also don't shootto incapacitate.
they're trained that if youdraw, they have these other
levels, right?
So they have the baton, theyhave taser, they have pepper
spray.
Um, if you draw your weapon, youmust shoot to kill.
(19:09):
That is the intention, right?
And so there is never anintention to draw your weapon,
to shoot someone in the, in the,and I hate to like talk about
this cause I might be wrong, butthis is what they shared with
me.
There could have been reform inthe last 15 years.
Maybe there's
SPEAKER_00 (19:23):
been some type of reform,
SPEAKER_01 (19:24):
but this is what I understood.
And so, um, Number one, they doneed to go through those
different levels.
However, based on the type ofrisk or the speed of the risk,
they may skip the levels and gostraight to their weapon.
And so what I learned fromhaving that conversation was
(19:45):
that, and I showed them and Iwas like, what would you have
done in this situation?
Here's a video of this littleboy.
He has a butter knife.
Butter knife is probably notgoing to kill you.
And it was so interestingbecause they were like, how do
we know the butter knife isgoing to kill us?
You could take out someone'scarotid with a butter knife.
You could take an eye out with abutter knife.
It was just things that for me,I'm like, I would wrestle the
butter knife out of this kid'shand.
(20:05):
That's what I would have to dobecause I'm not allowed to, I
don't have any their weapons.
For sure.
I know a lot of
SPEAKER_04 (20:12):
entry-level RBTs would have de-escalated the
situation with a
SPEAKER_01 (20:17):
butter knife.
A kid with a butter knife islike not okay.
But that's us too, working withkids with autism.
We're like, kid with a butterknife, no big deal, right?
And so for them, they're like,it was a weapon.
And so they feel like a weaponis a weapon is a weapon.
And so what I learned living andworking, I was born and raised
in San Bernardino County.
(20:37):
Um, and so, and I work with,because of that, because I've
worked in San Bernardino County,I work with a lot of black and
brown children.
And, um, back then the raceconversation was not on the
table.
That's not what we were there totalk about.
Um, I evolved in my career to,to be comfortable enough, having
the race conversations becausethey were very real to the
(20:58):
families that I served and theywere necessary because the
families had to understand whatthey were up against.
So what that taught me is, wasnumber one, have the race
conversation with my familiesand to let them know what police
said, which was, this is whatwe're going to do.
And 90% of them were like, notbudging.
This is how we're trained.
This is what we do.
And this is what's going tohappen.
(21:18):
And so the, the work, the onusthen became, I felt on me on
service providers to keep ourkids out of the system.
So my, I started to shift afterthat because I was like, great,
we're probably not going tochange how they behave.
respond because they're actuallydoing their job and the system
is working the way that it wasdesigned to work for them,
(21:41):
right?
We can't manage them, they don'twork for us.
But what we can do is we caneducate parents and we can
educate our team and we can makesure that the behavior team is
equipped to be able to work withfamilies who do have a risk of
their children ending up cominginto contact with law
enforcement.
So children with autism areeight times more likely to come
(22:06):
into contact with lawenforcement.
And then when you compound that,make that a child of color, it's
compounded on top of that.
And so the likelihood that thesekids with these behavioral
health issues are going to comeinto contact with law
enforcement, it's very high.
So I started to take my job veryseriously and have conversations
(22:27):
with families about what thetrajectory looked like based on
data for their child if we didnot work on managing their
behavior while we could.
That's really what I took fromit.
And I think that really kickedoff, even just that memory
kicked off.
It took me on a whole differentjourney in ABA because ABA
(22:48):
became a matter of socialsignificance in a different way
and because the social justicepiece I understood it better and
I was able to speak to this iswhat they're saying and we can
keep trying to fight againstthem but these men are doing
their job the way that they weretrained to do it whether it's
right or wrong are we doing ourjobs the way that we were
trained to do it right and arewe aware enough of what's
(23:12):
happening in terms of society tosay well how can I prepare my
child to exist in a society likethis If we can't change the
society, can we help ourfamilies to help their kids
exist safely in a society wherethis is the reality?
SPEAKER_02 (23:27):
Wow.
Thank you.
I never thought about that.
And that even gives, honestly, anew thought to even receptive
instructions, right?
We work on basic one-stepreceptive instructions with a
lot of our students.
individuals.
Historically, it would be muchmore decontextualized.
Touch your nose or spin aroundor things like that.
(23:47):
Now, it's more contextualizedwhere we try to make it have a
meaning rather than just randominstructions.
I'm thinking about that inrelationship to what you said
with law enforcement.
A lot of our kids that we workwith or individuals that we work
with really struggle with thatreceptive instructions.
As law enforcement is you'reexpecting that person that
you're giving that demand to, torespond immediately, you know,
(24:10):
get down or whatever it is, putthe knife down immediately.
And that person, like you said,might be nonverbal, but even
receptively might not understandthat instruction or might not
follow that instruction.
And it's just really interestingbecause we talk about, you know,
the stakes in an ABA session arewhatever the reinforcers at the
time, but You're talking aboutthe stakes could be life or
(24:32):
death.
And that's thank you for sharingthat, because that's really it's
unfortunate, but it's also veryeye opening.
SPEAKER_01 (24:38):
Yeah, they really are life or death.
I was having a recentconversation with someone that
is working on ascent.
And so her her her the centerthat she works in the treatment
center that she works in,they're putting in place ascent
based trainings for their teammembers and That's our name of
our
SPEAKER_02 (24:54):
company, Ascend Behavioral Solutions for Ascent.
Oh,
SPEAKER_01 (24:57):
beautiful.
Well, this may help.
So the team is talking about,hey, you know, the kids, you
need to ascend to services,whether or not they are, you
know, we've got to let kids havechoices and things like that.
And she says, yes, you know, butwhat her question was, I coach
her.
And so her question to me was,how do I explain to them that in
some families and also insociety for some children, um,
(25:20):
the right to choose does notexist.
The right to say no does notexist.
So, um, how, how do I, you know,first of all, in black families,
kids don't get to have a scent.
We don't, we don't, we don'tconsent to, to when we were
being raised and we didn't havea choice about anything that we
were told to be right.
(25:41):
And so, um, so these kids aregoing to get in trouble at the
lowest level.
We're going to get them introuble with their parents or
parents don't want us to teachthat the kids that it's okay to
say no or it's okay to refuse orit's okay you know and and so
she was saying like if you comeinto contact with law
enforcement you don't get tohave a conversation about
whether or not you consent tohowever however it is that they
(26:02):
are approaching you you have tofollow every single instruction
immediately to a tee and so whatI shared with her was I said
well this is really easy if wewant to make it a little bit
like simpler for just ABA tounderstand is we can teach
assent safely and If we makesure that we also teach the
child conditionaldiscrimination.
(26:24):
So these are the situationswhere you would have a choice
and where you would be able tosay, no, I don't want to, or can
I have more time?
And these are the situationswhere...
you just follow the instructionimmediately.
So safety, if you're runninginto the street and I yell stop,
you don't get to think aboutwhether or not you're gonna,
you're actually gonna stopbecause now it's a safety
(26:44):
concern.
There was a child last Februarynamed Ryan Gaynor who was killed
in his front yard in AppleValley.
Just a couple of, we served thisarea.
Could have very well been ourclient.
I was very emotionally likedrawn to his case.
And he was running when thepolice showed up He was running
(27:04):
out of the house with a gardentool.
And when the police said, stop,stop, stop, don't come any
further.
And he was not able to respondto that instruction.
And within, I think it was like12 seconds of the police showing
up on the scene, they did tellhim to stop.
(27:25):
There's body camera footage of,you know, he was running out of
the house with this tool and hewas shot and killed in his front
yard.
over parents just calling forhelp because he was having, he
was in behavioral crisis.
And so for me, what I felt likewas, of course, there was a big
social justice issue there.
We went to the press release andwe got to be a part of it.
(27:47):
But the issue for me was, wherewas his behavior team?
And why did the parents have tocall the police?
Because once the police show up,they do have to do their job.
And again, in the way thatthey're taught to do it.
Um, and so that's just anexample of like, yeah, the, the
client or the person might notbe able to respond.
(28:08):
Um, how can we keep them out ofthe relationship with law
enforcement for as long as wecan or forever, right.
And, or give them the tools tonavigate law enforcement even
for some of these, um, some ofthese kids, because it is their
reality that they will come intocontact and they do need to know
how to respond in thosesituations.
SPEAKER_04 (28:28):
Wow.
That's, um, Let's think ofhypotheticals here.
I mean, you mentioned even theway the process is in taking
that emergency call.
We can start looking at thelanguage the parent would use
that might alert those people tomaybe show up with rubber
bullets.
I'm trying to get to a pointwhere there is a greater level
(28:51):
of understanding, despite yourvery...
astute observation that we'renot going to change that
protocol in terms of my baton,my spray, my taser, now I'm
shooting to kill.
And again, I love the way youposit that protocol for them and
the idea that you say, look,we're likely not going to change
(29:14):
that.
So what are we doing on theother end?
And then maybe to push on thatquestion a little bit more, I
mean, what else could be done toreally inform, and you probably
have some of these answers,Portia, inform parents on how
they even approach first thiscrisis management system before
that system, then enacts thepolice that then is much better
(29:36):
informed about the situation andhow to escalate it in a way that
can maybe avoid death.
You know, again, maybe I'masking some very open-ended
questions, but give us yourinsight as far as your work
goes.
SPEAKER_01 (29:50):
Yeah, well, I think coordination of care is on the
back burner for a lot of ABAproviders, right?
Something that the insurancesays we should be doing.
It's very unregulated
SPEAKER_00 (30:00):
at most ABA companies.
Excellent
SPEAKER_01 (30:01):
point.
Mine included, like I didn'thave a code, a special label or
anything inside of our schedulerthat our team could use labels
to say this particular phonecall was coordination of care.
And I think because we have sucha young audience, providers in
ABA, I don't know if they'reintimidated, or they're just not
being taught how to coordinatecare, not only with it, they're
(30:23):
showing up to school, they knowthe teacher, they know the
speech therapist.
But I mean, I've coordinatedcare with every single I made a
point to say who all doanything, who is all a member of
this child's life.
Who is in this job?
Like, Grandma, bring me Grandma.
I want to know the people atchurch.
(30:43):
I want to be familiar with thedoctor if they're prescribing
medications.
A lot of times we don't get intothat because ABA is a very rigid
field.
And people in ABA can be veryrigid.
SPEAKER_02 (30:58):
That's
SPEAKER_01 (30:58):
an understatement.
Yeah, well, thank you.
I try to use the word very tomake sure that it's like, but
yeah, it's the rigidity thatwill say, well, that's outside
of my scope.
And it's like, well, first ofall, human behavior is not
outside of your scope.
And all the areas where humanbehavior exists, you do have to
be able to navigate at leastconversations around how things
(31:19):
impact you.
human behavior and so um if wehave i years and years back i
had a kid who he was engaging inhigh levels of aggression um and
his parents were getting olderdad had a bad back and he's like
we got to do something we neverwanted to do medication we
reduced the behavior enough andfrequency but the intensity when
he did engage in the behaviorthe intensity was still very
(31:40):
high and parents could notcontrol it um and so what they
did was they first of all theyasked me what i thought about
medication and i stuck to myethics code and i let them know
I don't, I don't think aboutmedication.
Um, but if they're going to walkthat journey with their child,
um, that I can help pinpointwhat happens to the child's
behavior when medications areadded.
(32:03):
And so I had a relationshipwith, um, the doctor who would
always let me know if there wasa small change, even if it was
like a 0.02, um, on the dosageor whatever.
And I would drop phase changelines every single time there
was a change because theytitrated him up really slowly.
Um, We looked at that data very,very closely.
(32:23):
And what I noticed is that theywere giving this child
medication for like psychiatricmedication for outbursts, for
aggression.
I think it was like Abilify.
So, of course, kid gained abunch of weight.
Like, you know, it was justpretty bad.
But he was a zombie.
So behavior did kind of stop.
He wasn't really himself.
And parents just didn't like it.
(32:45):
So they went to the drawingboard.
And so the doctor is like, OK,so what I was able to explain to
the doctor was what's actuallyhappening.
The underlying cause of thisbehavior is that he has
obsessive thoughts.
It wasn't necessarily like amatter of he's just an
aggressive child because hewasn't.
He had obsessive thoughts.
And what was happeningbehaviorally was that he would
(33:09):
just think about something overand over and ask for it over and
over.
And every time he got a no, hewould.
become aggressive again.
So then he may stop after awhile, like, okay, I'm not going
to ask for trains for a week,but if I see a train now, here I
go for this next week, I'm goingto have a problem because I'm
going to ask to go and buy atrain and see a train near the
(33:30):
train and all of that.
And so if we could stop himfrom, if he could get over it,
right?
Like we said, no.
And then that's it.
If we could stop him.
Cause we tried on the behaviorside, we tried to get him to
like, Hey, we were evenrecording number of times he
would ask after he was told no,like tally every single time he
asked, see if we can reduce thenumber of times that he would
(33:52):
ask, right?
Like a DRL.
That's probably the only time Iever use it.
And so, and we were able to getit down to an extent, but again,
when he, whenever he would thinkabout it again, he would, he
would escalate and the intensitywas so high.
So I let the doctor know, Idon't know if this would be
appropriate, but is there amedication that would, that
(34:13):
would deal with the underlyingcause of the obsession?
Like something that you wouldgive someone for OCD instead of
something that you would givesomeone for like psychiatric,
you know?
And so the doctor was like, youknow, that does make sense.
Parents were willing to try it.
That's the medication that hewas prescribed.
And we saw, huge improvements inhis behavior because he was able
(34:34):
to tolerate no, because theobsession was, was stopped.
So, but I think that thecoordination of care to that
extent is necessary to protectchildren, you know, socially,
especially as they get older, wehave to be willing to have
conversations with every singleperson that touches the kid,
especially these kids.
And also we have to be willingto understand other diagnoses
(34:56):
outside of autism.
And also understand otherservices that can exist either
through our organizations orthat already exists in the
community that are not just forchildren with autism.
They think that's where we putourselves into a box and we're
not really providing the serviceto every child who needs it in
the way that they need itbecause we are thinking about
how to treat autism.
(35:18):
And that is limiting.
It's limiting how effective wecan be with the science and all
the different places where wecan apply the science.
to meet the needs of the kids.
SPEAKER_04 (35:30):
I really enjoyed that account of collaborative
treatment.
I mean, that can be verytime-consuming, very difficult
to achieve.
I commend you on your efforts tomaybe...
engage another camp that can bea little bit difficult to engage
that being, uh, physicians.
Was this a specialist?
Was this the child'spediatrician?
(35:51):
Do you recall?
SPEAKER_01 (35:52):
It was, um, it was a psychiatrist, a child
psychologist.
So it wasn't, or hispsychiatrist, it wasn't his
primary care, but he had had apsychiatrist dealing with his
medications for a while.
SPEAKER_04 (36:03):
That's incredible.
SPEAKER_02 (36:04):
My buddy's a psychiatrist and he talks about
how a lot of the medications areoff label for kids.
There's not a lot of on labelmedications for kids and it's
very interesting how becausewe've taken part of some of the
psychiatrist visits and how alot of times they're 15 minutes
and it's like how are thingsgoing and the parents are like
it's terrible and it's like okaywell do we need to increase the
(36:26):
medication do we need to changethe medication and i'm sitting
there thinking about it'sterrible is that just the
medication?
Uh, are we sure that that's thereason?
Could there be other stressorsin the environment?
Could the parents be respondingor not responding correctly?
Um, so it's very interestinghow, um, and I know this is
making it seem like I'manti-medication.
I'm not saying that at all.
(36:48):
Um, that's just one variable ina very multivariate situation,
but has huge side effects asthose medications are titrated
and changed.
And I just, you made me thinkabout it with your example, how
so often these things are kindof changed willy nilly, uh, With
so, so many side effects.
And maybe it's like you said,maybe even not even the right
medication or maybe it is theright medication, but the
(37:09):
parents not doing the behavioralprotocols that are recommended
by the behavioral team.
So it is.
SPEAKER_01 (37:16):
And the thing about medication, I don't, I don't
know if I'm anti-medication, butwhat I'll say is that I do
think, well, you know, ABA wouldsay rule out medical issues
first.
That's what science says.
But then at the same time, Ifeel like we should rule out
whether or not our behavior planworks before we venture into
(37:37):
medication.
Because once the child is onmedication, if the medication
works...
then we don't get to ever knowif our intervention could have
worked without medication.
So if the medication actuallyremoves the behavior from being
a problem, sure, we can teachall these skills.
But unless this family, and mostfamilies do not, but unless this
family wants their child to beon medication forever, and that
(37:58):
to be what's actually managingtheir child's behavior and the
only thing that's managing theirchild's behavior, we do have to
find out Can we see behavioralprogress without the medication?
Will the child ever be able tobe off of their medication?
And that's where it just getskind of like sticky, right?
Because we believe thatsometimes parents will medicate
(38:20):
their kids because they don'tknow what to do and they don't
have the support.
But you can send the rightbehavior analyst in there.
And I've had kids that have comeoff of their medication, right?
Where we've slowly titrated themoff their medication.
It should be the goal, right?
Yeah, absolutely.
But you have to be able tocollaborate with their doctor
and with the family to be ableto do that.
SPEAKER_02 (38:41):
Yeah, absolutely.
In my experience, medication ismost effective when I have an
individual that I'm working withthat is not able to be receptive
or accessible to the behavioraltreatment because of maybe they
have an obsessive thoughts ormaybe they're just so
overstimulated.
They're not able to even attendfor a second or they're the
(39:01):
opposite.
They're so understimulated.
They're just like checked out.
So maybe that's just my personalexperience that that's what
medication can be very useful tohelp that individual get in the
best physiological state to bereceptive to the treatment and
hope that the behavioraltreatment will take over and
then we can titrate themedication down over time.
SPEAKER_01 (39:20):
Yeah, because they're going to give it to you.
If a parent goes in and asks forthe medication, they're going to
give it to you.
It's the diagnosis that I'malways concerned about because
what are we medicating?
Are we medicating somepsychiatric issue?
Does this child haveschizophrenia and that's what
we're medicating?
Okay, that makes sense.
But if we're just medicating,you know, aggressive behavior,
(39:41):
there should be a diagnosisconnected to that outside of
autism before medications aregiven.
SPEAKER_04 (39:49):
You alluded to this.
Is there to date an autismspecific medication or are we
doing everything off labelstill?
SPEAKER_02 (39:57):
I can't speak to...
I know my psychiatrist friendsaid the majority of it's
off-label.
I don't mean that means all ofit's off-label.
SPEAKER_04 (40:04):
I'm not sure if there's been something approved
specifically for autismtreatment, to your point,
Portia.
I think that's a reallyimportant point.
I ventured into that with...
We were part of a group that wasactually an extension.
We were the ABA department atpsychiatric...
a series of psychiatric centersand clinics here in San Diego
for a little while.
(40:25):
And we did try to interface withthe psychiatrist there to some
minimal success.
Again, I think Dan alluded tothe point earlier about, you
know, we have these 15 minuteconsultations, don't necessarily
have a whole lot of time foryour guys' questions.
But again, they were receptiveto some of the experiences, we
were able to learn a little bitmore about how to help them as
(40:47):
part of the behavior service.
And then I remember venturinginto the idea of what we're
talking about, I guess, in asense is
neuropsychopharmacology, right?
Seeing the effects of amedication on the behavior,
which to your point, Portia, wedon't talk about enough.
Maybe we should talk about morein terms of phase change lines
and really understanding how themedications work.
And that's where I'll kind ofpose this question in terms of,
(41:11):
maybe teaching parents about theside effects, the therapeutic
effects, knowing that sometimesside effects can discourage a
family from using medication,but those can be behaviorally
managed as well.
The idea that therapeuticeffects should be reinforced.
If your child is now, some ofthose behaviors went away and
they're responding more, that'ssomething that we need to be
(41:32):
ready for behaviorally toprovide reinforcement and really
make it a collaborativetreatment between the behavior
and the medication.
And then maybe understandingsome pieces like, you know,
stimulant medication with regardto, say, a comorbid ADHD
diagnosis doesn't necessarilymean your child is going to sit
down and attend.
(41:52):
In fact, one of the therapeuticeffects might be that they might
move around more, in which case,are you ready to then incite the
learning process?
So I don't really have aquestion, but I think you bring
up a lot of those points thatmaybe we don't look at closely
enough.
I just happen to have a littlebit of a background in graduate
school, so I've always beeninterested in that.
(42:14):
And I remember having thisconversation with you early on
and saying, wait, so getting theprescription is one thing, the
endogenous changes is the otherthing, but even getting that
pill into your mouth, that's...
behavioral that's us yeah and wedon't even think about that
right so the idea that hey mychild's chewing on their shirt
we stopped the medication overthe weekend okay is that what
(42:37):
your psychiatrist wanted you todo because these things have to
compound there's a as an upgradetime there's you know a lot of
things that happen so anyway ijust i'll put that out there for
commentary
SPEAKER_02 (42:48):
i do have a question for you um so you talked about
the importance of collaborationof care um one thing that i've
seen in san diego and i meanwe're a pretty big city um we
theoretically have a lot ofresources but sometimes that
collaboration of care breaksdown I remember I had a 16 year
old that was constantly runningaway from the home and we would
set these contingencies and theparents would even try to you
(43:10):
know nail the windows shut andstuff like that but the
individual would be able to findways out and maybe if I was with
them longer we could have youknow, found like, you know,
short of putting them in aprison cell, like they could see
16, he'd be able to find a wayout.
So we talked to the regionalcenter here.
Um, and again, the resources forthat kind of stuff was very
(43:31):
limited.
It was kind of like, well, ifthey run away, call the cops,
but you're talking about try theways of us keeping them out of
that system.
But sometimes it seems like theresources and the care that
there's like something missingthat could be there to keep them
out of the system.
Um, But either that's we don'tknow where that is and how to
refer them there or that's notthere and it should be there.
(43:54):
Can you speak
SPEAKER_01 (43:54):
to that?
Yeah.
Sure.
I think, um, there are, thereare missing holes.
Um, there's either like the, theresource is missing or the
relationship is missing and wedon't know unless we explore the
relationship.
Right.
So, um, last year I did a kindof like a, it's a CEU event and
it was called We The People.
Um, and it was about RyanGaynor, this child who was
(44:16):
killed.
And it was like, what else couldwe have been done?
Like what was missing from this?
his family support system.
Um, because we have to startthinking like, what are the
family support systems thatexist
SPEAKER_00 (44:26):
already
SPEAKER_01 (44:27):
just in the area?
Um, and I learned so much, likeI learned that, um, They were
calling the police.
They had called the police fivetimes and the police did not
come out.
They had come out a few times,but this particular time they
didn't come out.
They referred them to psych.
So they were like taken to thehospital.
(44:47):
So they took them to thehospital.
And so on with the people, thepoint of it was collaborative.
So we had different players inthe community attend the CEU
event for a panel conversation.
And so there was a socialworker, a licensed clinical
social worker that was there.
And she was like, well, whathappens is the police will refer
(45:08):
them to the hospital.
SPEAKER_00 (45:09):
And
SPEAKER_01 (45:10):
then when we get them to the hospital, it's our
job just to get them stable andthen release them.
SPEAKER_02 (45:15):
Exactly.
SPEAKER_01 (45:16):
And I was like, okay, so what is stable?
If you give them the medicationor you just keep them in the
hospital room until the behavioris passed and then you just send
them right back with theirparents.
You don't send them with anyresources.
You don't send them with nextsteps.
You don't speak to theirbehavior team.
You just...
Send them out, stabilize themand send them out.
So it's like, wow.
So even just understanding whathappens in all of these, like
(45:40):
what happens in the chain ofevents.
So how does it get to lawenforcement?
And of course, law enforcementwas like, we do have emergency
response teams.
But number one, the emergencyresponse teams were coming out
getting hurt.
And so they didn't want to comeout anymore because they're
coming out unarmed.
coming out and getting hurtbecause they weren't they
(46:02):
weren't behaviorally trained orsupposedly they were but then
they they didn't want to do thisanymore because they were
getting hurt so um so they werelike so we just started
referring back tohospitalization well then once
that child gets off of their 5150 72 hour hold they're just
standing back with no resourcesso it's like when the child is
on the hold or in the hospitalis there um a behavior analysis
(46:26):
unit that comes to that child'sfamily and talks to them about
what they have in place and whatresources are available to them
so that when they aredischarged, the family, they can
help the family tap into thesetypes of resources.
This is even more important infamilies where the education
isn't there, the money isn'tthere, the language may not be
there, right?
(46:46):
Where you guys are in San Diego,I'm right here, so lots of
Spanish speakers.
Almost 70% of the families thatwe serve speak Spanish.
And so making sure that theresources are accessible.
And I feel like it almost seemslike everyone has a little piece
of the puzzle of a resource oreven a list of resources that
might be available to yourchild.
But there's no...
(47:06):
resource center that is sayinghey we're going to have someone
before we discharge you comefrom our behavior analysis team
or from our resource center andtalk to you about all the
resources so we have behavioranalytics services we have this
that and we're going to call youback and make sure that you are
able to tap into these resourcesbecause we know that they're
urgent at this point for yourchild right there's there's no
(47:27):
liaison it's bringing togetherall of the information in terms
of what resources already existto make sure that families I
can't even imagine Imagine howhard it would be to just have to
search the World Wide Web forwhat is available to your child
in a community where you paytaxes.
SPEAKER_02 (47:45):
Which the regional center is supposed to do that.
And they do a wonderful job, butthere's still a lot of
loopholes.
There's still a lot of holes inthat.
SPEAKER_01 (47:55):
Yeah, they also don't serve every family, right?
So they have eligibilityrequirements.
And so what if your child is noteligible for regional center
services?
But I mean, you know, they are,that removes every resource that
regional center has.
Also, we're looking at capacity.
How many of these services canregional center even get out if
(48:15):
they have a very lengthy, verygrueling process to even add new
providers to their servicedelivery line?
So it's like the providers thatare in place, there's also not
very great resources.
checks and balances for whetheror not they're able to provide
the services, whether or not theservices are quality.
(48:35):
They do a good job at surveyingwhat services are needed, but
then they limit who can providethose services.
And so because they do that, theteams that are assigned to these
kiddos, they're just overcapacity too.
So no one is really getting highquality anything because
everyone's trying, as autismcontinues to to spiral and grow
(48:56):
out of control.
There just aren't enoughproviders to provide the
services that are necessary.
And the providers that do exist,my pastor actually said
something really interesting.
He was like, the providersexist, but y'all are closed on
nights and weekends.
And that's when the kids aregetting in trouble.
SPEAKER_00 (49:13):
They're not in school.
SPEAKER_01 (49:16):
That's when they're at home with their parents
getting into things, right?
They're stealing on the weekend.
They're sneaking out of the homeafter hours.
You guys are closed.
The behavior team is unavailablebecause you guys don't have any
emergency response team.
And I was like, wow, you'reabsolutely right.
So these are service deliverylines that if we're smart, we
can find the gaps.
And from a business perspective,from an organizational
(49:36):
management perspective, we cansay well this is what's missing
how can we create it right do wehave emergency response teams
because I cringe because I seebehavioral providers say yeah
this kid needs a higher level ofservice than what we can provide
and I'm like yeah ethicallywe're supposed to do that the
clinician doesn't feel thatthey're qualified but at the
same time who's a better serviceprovider than the behavior team
(49:58):
and where are you referring himout to because there's no one
else that can really do what wedo but we get so afraid to do it
because it requires us to stepoutside of that little box that
I think aba providers want tostay inside of to be comfortable
with what they learned in theirmaster's program
SPEAKER_02 (50:12):
well that's what dr scott was talking about a couple
of episodes about his kind ofgripe with the bacb right about
that we have to have that highlevel of competency but that
really limits our ability andour scope because if we don't
have the high level ofcompetency we can't go out and
work on things and if we'retraining under somebody who's
done it that means we're justregurgitating the way that we've
done that they've done it sothat that was an interesting
(50:35):
discussion that you kind of justalluded to as well that uh One
of our previous guests broughtup.
SPEAKER_04 (50:41):
Whoa.
And this concludes part one ofour conversation with the
illustrious and ever articulatePorsche James.
Please make sure you return forpart two.
In the meantime,
SPEAKER_00 (50:52):
always analyze responsibly.
SPEAKER_03 (50:55):
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.
Welcome to ABA on Tap, where our goal is to find
(00:14):
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
look back into the ingredientsto form the best concoction of
ABA on tap.
In this podcast, we will talkabout the history of the ABA
(00:35):
brew, how much to consume toachieve the optimum buzz while
not getting too drunk, and therecommended pairings to bring to
the table.
So without further ado, sitback, relax, and always analyze
responsibly.
Thank you.
SPEAKER_04 (00:54):
All right, all right.
Welcome back to yet anotherinstallment of ABA on Tap.
I am your ever-grateful co-host,Mike Rubio, along with Mr.
Daniel Lowry.
Mr.
Dan, it's a Friday, sir.
That's unusual for us.
It's great to see you.
We're here on a Friday.
Clearly, we've got somethingspecial.
SPEAKER_02 (01:14):
I'm super excited to be here on a Friday, on a lunch
break in between your clientswhile you've been able to
accommodate because we were soexcited to have Portia on.
So yeah, changing the Sundayvibes for the Friday vibes.
So the weekend is about to beupon us.
SPEAKER_04 (01:28):
Now, I heard our guest today, our guest Portia
James, might be talking to usabout systemic variables and
burnout in our industry.
And as you said, I'm literallyon a lunch break between
clients.
We're very proud business ownersof a new ABA venture, medical
services, autism treatment.
So this is just the name of thegame.
(01:50):
And this was scheduled waybefore we had new clients and
new employees to support.
So I'm very glad to be here on alunch break.
Very excited.
So without further ado, Ourguest, Portia James.
Hey, hey.
Hey,
SPEAKER_00 (02:10):
hey.
UNKNOWN (02:10):
Come on over.
SPEAKER_04 (02:10):
All right.
Portia, how are you doing?
We're so grateful for your time.
You might be on your lunchbreak.
How are you doing today?
SPEAKER_01 (02:17):
I am on my lunch break.
There's no lunch on my deskbecause my husband is gone for
the day, but I'm doing well.
I'm grateful to be here.
I'm really
SPEAKER_04 (02:27):
excited.
Thank you so much for your time.
We know you keep very busy.
You've got some very importantthings to share with us today.
We're very happy to talk topeople who are not directly
necessarily working maybe onautism intervention services,
but have taken a broader scope,which I think is very important
to the growth of our field.
I think you've got a lot ofthings to share with us about
(02:48):
that today.
We love to start with the originstory.
Tell us how you got started inABA, what other things are part
of your background, what keepsyou driven, family, anything
that you want people to know outthere.
Give us the origin story,Portia.
SPEAKER_01 (03:07):
Yeah, absolutely.
Oh gosh, where do I start?
So I have been in ABA for almost20 years.
Actually, I'll be at 19 yearsthis June 3rd since I started in
ABA.
Congratulations.
Shout
SPEAKER_02 (03:22):
out to you.
Oh,
SPEAKER_01 (03:23):
thank you.
I'll be doing a big, I'll bedoing a world tour next year.
SPEAKER_02 (03:28):
The 20th anniversary.
SPEAKER_04 (03:29):
We better get noticed.
I want a shirt.
I want
SPEAKER_01 (03:32):
a shirt for sure.
I'll have t-shirts.
I'll have CD covers.
A hat.
All of that.
Okay, perfect.
So I started as a behaviortechnician during my
undergraduate internship, and Ijust have kind of throughout the
years worked my way up.
In Southern California, we havethe mid-tier for most of our
insurance companies.
(03:52):
I work with a lot of Medi-Cal,Medicaid clients.
And so I had the mid-tier.
I then got my BCBA in 2011.
And so excited to continue, Ithink, in work that I loved back
then when I was in home.
And I never imagined that Iwould love that.
(04:13):
not being with my kids or notbeing with my uh family but over
the years i just kind of liketook the slow road and i grew
and i had a lot of differentopportunities to practice
teaching the principles ofbehavior analysis, not only to
people that I managed andmentored, but also to families.
And so I've had some prettyinteresting opportunities to
(04:36):
train the San Bernardino CountySheriff's Department graduating
class in behavioral strategiesand recognizing signs of autism,
and how those differ from like,you know, signs of, you other
distress, mental illness andthings like that.
I had the opportunity to teachparent training for the Inland
Regional Center.
I served for a little while asthe behavior consultant for
(04:58):
Pomona Unified School District.
So I got to go in and do all oftheir teacher in-service days.
My master's is actually inteaching.
So at that time, I was using mymaster's to teach teachers how
to set up their classrooms sothat they could be effective
with kids with autism.
That was a really fun So for me,I think just throughout the
(05:20):
years, what I've enjoyed most isbeing able to expand upon just
general ABA in-home services.
I do have three children.
I should mention them.
I've been married for nine yearsthis summer, and I do have three
children.
They are typically developingchildren, ages 16, 10, and 6.
(05:42):
So they keep me very busy.
I'm a homeschool mom as well.
Wow.
SPEAKER_02 (05:47):
well thank you for giving us some time man
SPEAKER_01 (05:51):
this
SPEAKER_04 (05:53):
is an extended recess is that what's going on
here
SPEAKER_01 (05:56):
yeah this is actually it's Friday Fridays are
fun Fridays yeah my husbandtrains Jiu Jitsu he is working
on his black belt but he has acouple fighters that he manages
and so it's fight weekend and somy kids are gone and my husband
just left so that they can go dowhat they need to do to get
(06:16):
ready for fight weekend Verydifferent life than the NBA
life.
SPEAKER_00 (06:20):
Wow.
SPEAKER_02 (06:21):
Wow.
Yeah, I'm a huge UFC fan, so Ilove the jiu-jitsu stuff.
Yes, big UFC fans.
My kids, too.
SPEAKER_04 (06:28):
I catch it here and there.
I catch it here and there.
That's a very dynamic family youjust described.
Congratulations.
Three great kids.
Nice working on the extendedprolonged marriage.
That's an incredible thing,especially these days.
You say typically developing,and I think that's a really...
poignant statement to make,especially when we're talking
(06:48):
about, say, autism services orABA services for autism
intervention.
How would you differentiatebeing a parent, not that either
of us would know being a parentof a neurodivergent child, for
example, but you made animportant differentiation there.
Tell us about it.
What do you think the differenceis in what you do and what a
(07:10):
parent with an autistic childmight be doing?
And then where are thecommonalities, perhaps?
SPEAKER_01 (07:16):
Yeah, I mean, I think parenting is hard.
Common parenting is challenging.
SPEAKER_00 (07:22):
It
SPEAKER_01 (07:22):
challenges, it grows us.
But I've been in human analysislonger than I've been a mom.
And so I'm always really carefulto make sure that I'm clear with
respect and honor to parents whodo parent children who have
special needs or areneurodiverse.
I think it's important torecognize the things that we
(07:46):
take for granted as parents, thelittle things that we get access
to, the experiences that we getto have, the conversations that
we get to have with our kids,even the things that agitate us,
right?
Like arguing back with them.
But getting to do that, right?
And I've worked with so manykids who either didn't have
language or, you know, we're notable, we're teaching
(08:09):
negotiating, right?
We're teaching how to answer aquestion about how school was
today.
My kids, they were able to pickup developmental milestones just
by being with other kids.
And even though there's researchthat suggests that when you put
any kid, a neurodiverse child aswell, with a, another child peer
(08:33):
mediated learning is so robust.
Um, however, the rate, the paceat learning, right?
So there's things that my kidsjust kind of picked up and I was
like, who taught you how toread?
Um, that the kids that I, thatI've historically worked with,
we've had, I, I, I know what itwas like spending six months or
a year, 18 months pottytraining, a child working the
parent through the things that,you know, just, I had parents
(08:56):
that would say, Oh, if I couldwave a magic wand, I would just
want my child to be able to tellme if they got hurt today at
school or if their stomach hurtsor, you know, things like that.
And so I always want to makesure that, that I do, I get
asked a lot.
Do you have children on thespectrum?
And I do not have children onthe spectrum.
My kids are very different.
(09:17):
Their, their needs aredifferent.
Their demands are different.
But I do recognize howprivileged I am to have children
that are, I don't have to stepout of the average typical
difficulties of parenting inorder to parent my child.
We don't have three or fourdifferent types of therapies.
(09:38):
I'm not fighting the schooldistrict.
And so I think that those thingsneed to be acknowledged because
parenting is generally hard.
But when you add the layers andlayers of life that most of my
parents have had to add, itbecomes, I just told you about
the dynamic, like nature of mylife.
(09:59):
Now, imagine if I had a childwho had speech and occupational
therapy and IEP meetings and,and also just wasn't able to
maybe go with the flow of theway that we have a very loose,
loose life schedule.
Um, we don't have very strictadherence to really any routine.
Yeah.
So we have fun Friday that iswithin our routine, but yeah, I
(10:20):
just, I acknowledge thatbecause, um, I think that when
we're talking about ABA andautism, it's also important to
acknowledge that I do have threechildren and as much work as it
is, it will never even hold acandle to some of the
experiences that I've seen myfamilies have to add to their
agendas, but also the thingsthat they miss out on, the
(10:44):
normal going out to dinner, thegoing to the grocery store,
being with family at parties,having a babysitter so they can
go to date night, things likethat, that our parents, the
parents that I've served havejust really missed because they
have been caring for their childin ways that most of us really
could never imagine.
SPEAKER_04 (11:03):
Thank you for that perspective.
I think you You hit a lot ofimportant pieces that really
could guide us as serviceproviders in terms of what
things we recommend.
What are we suggesting theparents are doing to actually
address some of the challenges,behaviorally or otherwise?
Sometimes we can load up thatplate a lot more than it needs
(11:24):
to be loaded up, and I thinkthat teaches us a lot about how
to be mindful.
I know I've said it.
a million times, so to speak,here on the podcast.
But to your point, Portia, theidea that I've got three
children myself.
I've got two teenagers and thena younger four-year-old.
And every time
SPEAKER_01 (11:42):
I...
That's not starting over.
Yeah, yes,
SPEAKER_04 (11:44):
exactly, exactly.
Now I have to practice what hereaches.
Glutton for punishment.
I think she was for trainingpurposes, right?
I was starting a business, earlystart, intervention.
She has to train me.
But I like to say that withevery one of my children, I get
1,000% better at what I doprofessionally because I gain a
whole new perspective now andhaving two children and
(12:05):
understanding what that balanceis and then now the third
children certain age discrepancyand then to your point most
importantly adding all theselayers of intervention the
stress of now discussing an IEPas much as it's a useful service
it comes with a lot of work so Ithink that's a really important
perspective that you you lent tous there thank you so much
SPEAKER_02 (12:25):
Yeah.
You mentioned that you've done,you did parent training for the
regional center out in Pomona.
Was that correct?
The Pomona Regional Center?
SPEAKER_01 (12:33):
It was the Inland Regional Center.
So they're located in SanBernardino.
SPEAKER_02 (12:38):
San Bernardino for the regional center.
But before that, you worked withlaw enforcement, right?
The San Bernardino Sheriffs?
SPEAKER_01 (12:45):
I did.
I didn't work with them.
I actually just had anopportunity from a parent who
was going through the graduatingclass.
She had a child with autism andshe said, you need to come and
speak to them because there wasa child who was killed and by
the police, not in SanBernardino, but in another
state.
She heard about it and she said,this could be my child.
(13:06):
This could be any of our kids.
And there is no the trainingthat we that we are required to
do is not sufficient.
Will you come and speak to mygraduating class?
And so, of course, of course, Iwas open to that.
SPEAKER_02 (13:20):
There was just an individual that made the
national maybe in Boise orsomething that individual with
special needs that got killed bythe.
Police, like a month ago orsomething, made national news.
And again, it's not cut and dry,but that's certainly a need.
In San Diego, we have the PERTteam.
I think it's the PsychiatricEmergency Response Team.
(13:45):
There you go.
SPEAKER_04 (13:46):
Is that just particular to San Diego County?
SPEAKER_02 (13:48):
No, I think, but I know we have that in San Diego
County.
So can you talk a little bitabout your experience in talking
with these individuals?
Did you find that they werereceptive?
And the reason I ask is I workfor a company also called
Proact.
Are you familiar with Proact?
SPEAKER_01 (14:03):
Yeah, I am.
SPEAKER_02 (14:03):
Okay.
So I worked for a company calledProact and, you know, we teach a
lot of de-escalation and crisismanagement strategies.
And we don't train a whole lotof current law enforcement, but
a lot of ex-law enforcement.
And the ways that they go aboutthings sometimes isn't the ways
that we would teach going aboutthings, about maybe client
empowerment and offeringalternatives and things like
(14:25):
that.
So can you speak to maybe thatexperience?
Because I'm really interested tohear your experience with law
enforcement, how they werereceptive, what you said.
Can you take us in thatconference room?
SPEAKER_01 (14:36):
Sure.
It was very eye-opening.
I don't have good news toreport.
It was eye-opening for mebecause I was younger.
This is a really long time ago.
Maybe 15 years.
Maybe 12 to 15 years ago.
And I went in, I am a verypositive person.
(15:03):
We gather that
SPEAKER_04 (15:06):
immediately.
We appreciate it.
Thank you.
SPEAKER_01 (15:08):
Thank you.
I try to stay on the up and up,you know?
So I went in, I have my littlepresentation and I was just
like, I'm going to change theirperspectives.
It's going to be so beautiful.
We're going to come together.
We're going to do a handshakeand everybody's going to think
kumbaya.
And it was tough.
It was really tough because theywere engaged.
They were engaged.
(15:29):
I spoke to them about how toidentify some of the
differences, behaviors that theymay see.
So, for example, they need toknow if a person is nonverbal,
they may not be ignoring them orhow a person with autism may
respond to being afraid.
Right.
So aggression, even aggressivebehavior could be fear.
(15:50):
Right.
And how that might talk themthrough, like how that might
look different thanschizophrenia or, you know, if
they were to find someone, howthey can get informed, who
should probably be with thatperson.
If a parent calls them, thetypes of questions that they
should ask before they go out orwhen they get there.
(16:11):
Just how to assess the situationa little bit better is what I
really wanted.
There's not much I could do inlike a two to three hour
presentation.
But it was really interestingbecause there were some, and
maybe it was that the officerswho may have had children with
autism or no children withautism that seemed really
appreciative that were like,yes, this changes me forever.
(16:33):
I would say out of about 50 ofthem, there may have been two or
three that were like, I'mforever changed.
Thank you for sharing this.
I will be more mindful.
Um, during my presentation, Ishared an example of a child who
was shot, um, he was chasing hismom around the kitchen Island
(16:53):
with a knife over a butterknife, a butter knife over a bag
of Skittles.
Um, and he was denied access tothis candy and it made national
news and I had heard about it.
So I was like, perfect.
I'm going to use this as anexample.
Um, because you know, lawenforcement really wants us to
(17:13):
know what, that their job, Ithink what I learned is that
their job is to eliminate risk.
However, because of what theydo, their perception of risk is
much higher than ours.
Now you would think like in somesituations, like my husband,
he's a fighter, right?
So he goes into the cage and hedoes mixed martial arts.
(17:35):
And so for him, the perceptionof danger is is he has a higher
threshold because he has beenpunched in the face on purpose
for fun, right?
So for him, he's like, I know itsounds scary to you guys, but
for me, once you've done it acouple of times, it's just not
that big
SPEAKER_00 (17:50):
a deal.
SPEAKER_01 (17:51):
For police officers, I almost feel like they have
this response.
They're trained to see danger ineveryday things, which is
something that we canunderstand,
SPEAKER_00 (18:02):
right?
SPEAKER_01 (18:03):
And so- it almost feels like their threshold for
danger is even lower.
And so I learned a couple ofthings.
Number one, they're not trained.
And my husband always says, whydon't they just learn how to
fight?
Yeah.
Yeah.
Why shouldn't they all have totake my martial arts class?
But I learned that number one, alot of them, and they all agreed
(18:27):
with each other at the end ofthe day, I will go out and
protect and serve, but mymission is to make it home.
At the end of the night, I'mfirst, right?
Like whatever.
And I would rather accidentallypull the trigger than to not
make it home, than to be tooslow and not to make it home
(18:49):
tonight to my own family and mywife.
And so there's that.
And then they also don't shootto incapacitate.
they're trained that if youdraw, they have these other
levels, right?
So they have the baton, theyhave taser, they have pepper
spray.
Um, if you draw your weapon, youmust shoot to kill.
(19:09):
That is the intention, right?
And so there is never anintention to draw your weapon,
to shoot someone in the, in the,and I hate to like talk about
this cause I might be wrong, butthis is what they shared with
me.
There could have been reform inthe last 15 years.
Maybe there's
SPEAKER_00 (19:23):
been some type of reform,
SPEAKER_01 (19:24):
but this is what I understood.
And so, um, Number one, they doneed to go through those
different levels.
However, based on the type ofrisk or the speed of the risk,
they may skip the levels and gostraight to their weapon.
And so what I learned fromhaving that conversation was
(19:45):
that, and I showed them and Iwas like, what would you have
done in this situation?
Here's a video of this littleboy.
He has a butter knife.
Butter knife is probably notgoing to kill you.
And it was so interestingbecause they were like, how do
we know the butter knife isgoing to kill us?
You could take out someone'scarotid with a butter knife.
You could take an eye out with abutter knife.
It was just things that for me,I'm like, I would wrestle the
butter knife out of this kid'shand.
(20:05):
That's what I would have to dobecause I'm not allowed to, I
don't have any their weapons.
For sure.
I know a lot of
SPEAKER_04 (20:12):
entry-level RBTs would have de-escalated the
situation with a
SPEAKER_01 (20:17):
butter knife.
A kid with a butter knife islike not okay.
But that's us too, working withkids with autism.
We're like, kid with a butterknife, no big deal, right?
And so for them, they're like,it was a weapon.
And so they feel like a weaponis a weapon is a weapon.
And so what I learned living andworking, I was born and raised
in San Bernardino County.
(20:37):
Um, and so, and I work with,because of that, because I've
worked in San Bernardino County,I work with a lot of black and
brown children.
And, um, back then the raceconversation was not on the
table.
That's not what we were there totalk about.
Um, I evolved in my career to,to be comfortable enough, having
the race conversations becausethey were very real to the
(20:58):
families that I served and theywere necessary because the
families had to understand whatthey were up against.
So what that taught me is, wasnumber one, have the race
conversation with my familiesand to let them know what police
said, which was, this is whatwe're going to do.
And 90% of them were like, notbudging.
This is how we're trained.
This is what we do.
And this is what's going tohappen.
(21:18):
And so the, the work, the onusthen became, I felt on me on
service providers to keep ourkids out of the system.
So my, I started to shift afterthat because I was like, great,
we're probably not going tochange how they behave.
respond because they're actuallydoing their job and the system
is working the way that it wasdesigned to work for them,
(21:41):
right?
We can't manage them, they don'twork for us.
But what we can do is we caneducate parents and we can
educate our team and we can makesure that the behavior team is
equipped to be able to work withfamilies who do have a risk of
their children ending up cominginto contact with law
enforcement.
So children with autism areeight times more likely to come
(22:06):
into contact with lawenforcement.
And then when you compound that,make that a child of color, it's
compounded on top of that.
And so the likelihood that thesekids with these behavioral
health issues are going to comeinto contact with law
enforcement, it's very high.
So I started to take my job veryseriously and have conversations
(22:27):
with families about what thetrajectory looked like based on
data for their child if we didnot work on managing their
behavior while we could.
That's really what I took fromit.
And I think that really kickedoff, even just that memory
kicked off.
It took me on a whole differentjourney in ABA because ABA
(22:48):
became a matter of socialsignificance in a different way
and because the social justicepiece I understood it better and
I was able to speak to this iswhat they're saying and we can
keep trying to fight againstthem but these men are doing
their job the way that they weretrained to do it whether it's
right or wrong are we doing ourjobs the way that we were
trained to do it right and arewe aware enough of what's
(23:12):
happening in terms of society tosay well how can I prepare my
child to exist in a society likethis If we can't change the
society, can we help ourfamilies to help their kids
exist safely in a society wherethis is the reality?
SPEAKER_02 (23:27):
Wow.
Thank you.
I never thought about that.
And that even gives, honestly, anew thought to even receptive
instructions, right?
We work on basic one-stepreceptive instructions with a
lot of our students.
individuals.
Historically, it would be muchmore decontextualized.
Touch your nose or spin aroundor things like that.
(23:47):
Now, it's more contextualizedwhere we try to make it have a
meaning rather than just randominstructions.
I'm thinking about that inrelationship to what you said
with law enforcement.
A lot of our kids that we workwith or individuals that we work
with really struggle with thatreceptive instructions.
As law enforcement is you'reexpecting that person that
you're giving that demand to, torespond immediately, you know,
(24:10):
get down or whatever it is, putthe knife down immediately.
And that person, like you said,might be nonverbal, but even
receptively might not understandthat instruction or might not
follow that instruction.
And it's just really interestingbecause we talk about, you know,
the stakes in an ABA session arewhatever the reinforcers at the
time, but You're talking aboutthe stakes could be life or
(24:32):
death.
And that's thank you for sharingthat, because that's really it's
unfortunate, but it's also veryeye opening.
SPEAKER_01 (24:38):
Yeah, they really are life or death.
I was having a recentconversation with someone that
is working on ascent.
And so her her her the centerthat she works in the treatment
center that she works in,they're putting in place ascent
based trainings for their teammembers and That's our name of
our
SPEAKER_02 (24:54):
company, Ascend Behavioral Solutions for Ascent.
Oh,
SPEAKER_01 (24:57):
beautiful.
Well, this may help.
So the team is talking about,hey, you know, the kids, you
need to ascend to services,whether or not they are, you
know, we've got to let kids havechoices and things like that.
And she says, yes, you know, butwhat her question was, I coach
her.
And so her question to me was,how do I explain to them that in
some families and also insociety for some children, um,
(25:20):
the right to choose does notexist.
The right to say no does notexist.
So, um, how, how do I, you know,first of all, in black families,
kids don't get to have a scent.
We don't, we don't, we don'tconsent to, to when we were
being raised and we didn't havea choice about anything that we
were told to be right.
(25:41):
And so, um, so these kids aregoing to get in trouble at the
lowest level.
We're going to get them introuble with their parents or
parents don't want us to teachthat the kids that it's okay to
say no or it's okay to refuse orit's okay you know and and so
she was saying like if you comeinto contact with law
enforcement you don't get tohave a conversation about
whether or not you consent tohowever however it is that they
(26:02):
are approaching you you have tofollow every single instruction
immediately to a tee and so whatI shared with her was I said
well this is really easy if wewant to make it a little bit
like simpler for just ABA tounderstand is we can teach
assent safely and If we makesure that we also teach the
child conditionaldiscrimination.
(26:24):
So these are the situationswhere you would have a choice
and where you would be able tosay, no, I don't want to, or can
I have more time?
And these are the situationswhere...
you just follow the instructionimmediately.
So safety, if you're runninginto the street and I yell stop,
you don't get to think aboutwhether or not you're gonna,
you're actually gonna stopbecause now it's a safety
(26:44):
concern.
There was a child last Februarynamed Ryan Gaynor who was killed
in his front yard in AppleValley.
Just a couple of, we served thisarea.
Could have very well been ourclient.
I was very emotionally likedrawn to his case.
And he was running when thepolice showed up He was running
(27:04):
out of the house with a gardentool.
And when the police said, stop,stop, stop, don't come any
further.
And he was not able to respondto that instruction.
And within, I think it was like12 seconds of the police showing
up on the scene, they did tellhim to stop.
(27:25):
There's body camera footage of,you know, he was running out of
the house with this tool and hewas shot and killed in his front
yard.
over parents just calling forhelp because he was having, he
was in behavioral crisis.
And so for me, what I felt likewas, of course, there was a big
social justice issue there.
We went to the press release andwe got to be a part of it.
(27:47):
But the issue for me was, wherewas his behavior team?
And why did the parents have tocall the police?
Because once the police show up,they do have to do their job.
And again, in the way thatthey're taught to do it.
Um, and so that's just anexample of like, yeah, the, the
client or the person might notbe able to respond.
(28:08):
Um, how can we keep them out ofthe relationship with law
enforcement for as long as wecan or forever, right.
And, or give them the tools tonavigate law enforcement even
for some of these, um, some ofthese kids, because it is their
reality that they will come intocontact and they do need to know
how to respond in thosesituations.
SPEAKER_04 (28:28):
Wow.
That's, um, Let's think ofhypotheticals here.
I mean, you mentioned even theway the process is in taking
that emergency call.
We can start looking at thelanguage the parent would use
that might alert those people tomaybe show up with rubber
bullets.
I'm trying to get to a pointwhere there is a greater level
(28:51):
of understanding, despite yourvery...
astute observation that we'renot going to change that
protocol in terms of my baton,my spray, my taser, now I'm
shooting to kill.
And again, I love the way youposit that protocol for them and
the idea that you say, look,we're likely not going to change
(29:14):
that.
So what are we doing on theother end?
And then maybe to push on thatquestion a little bit more, I
mean, what else could be done toreally inform, and you probably
have some of these answers,Portia, inform parents on how
they even approach first thiscrisis management system before
that system, then enacts thepolice that then is much better
(29:36):
informed about the situation andhow to escalate it in a way that
can maybe avoid death.
You know, again, maybe I'masking some very open-ended
questions, but give us yourinsight as far as your work
goes.
SPEAKER_01 (29:50):
Yeah, well, I think coordination of care is on the
back burner for a lot of ABAproviders, right?
Something that the insurancesays we should be doing.
It's very unregulated
SPEAKER_00 (30:00):
at most ABA companies.
Excellent
SPEAKER_01 (30:01):
point.
Mine included, like I didn'thave a code, a special label or
anything inside of our schedulerthat our team could use labels
to say this particular phonecall was coordination of care.
And I think because we have sucha young audience, providers in
ABA, I don't know if they'reintimidated, or they're just not
being taught how to coordinatecare, not only with it, they're
(30:23):
showing up to school, they knowthe teacher, they know the
speech therapist.
But I mean, I've coordinatedcare with every single I made a
point to say who all doanything, who is all a member of
this child's life.
Who is in this job?
Like, Grandma, bring me Grandma.
I want to know the people atchurch.
(30:43):
I want to be familiar with thedoctor if they're prescribing
medications.
A lot of times we don't get intothat because ABA is a very rigid
field.
And people in ABA can be veryrigid.
SPEAKER_02 (30:58):
That's
SPEAKER_01 (30:58):
an understatement.
Yeah, well, thank you.
I try to use the word very tomake sure that it's like, but
yeah, it's the rigidity thatwill say, well, that's outside
of my scope.
And it's like, well, first ofall, human behavior is not
outside of your scope.
And all the areas where humanbehavior exists, you do have to
be able to navigate at leastconversations around how things
(31:19):
impact you.
human behavior and so um if wehave i years and years back i
had a kid who he was engaging inhigh levels of aggression um and
his parents were getting olderdad had a bad back and he's like
we got to do something we neverwanted to do medication we
reduced the behavior enough andfrequency but the intensity when
he did engage in the behaviorthe intensity was still very
(31:40):
high and parents could notcontrol it um and so what they
did was they first of all theyasked me what i thought about
medication and i stuck to myethics code and i let them know
I don't, I don't think aboutmedication.
Um, but if they're going to walkthat journey with their child,
um, that I can help pinpointwhat happens to the child's
behavior when medications areadded.
(32:03):
And so I had a relationshipwith, um, the doctor who would
always let me know if there wasa small change, even if it was
like a 0.02, um, on the dosageor whatever.
And I would drop phase changelines every single time there
was a change because theytitrated him up really slowly.
Um, We looked at that data very,very closely.
(32:23):
And what I noticed is that theywere giving this child
medication for like psychiatricmedication for outbursts, for
aggression.
I think it was like Abilify.
So, of course, kid gained abunch of weight.
Like, you know, it was justpretty bad.
But he was a zombie.
So behavior did kind of stop.
He wasn't really himself.
And parents just didn't like it.
(32:45):
So they went to the drawingboard.
And so the doctor is like, OK,so what I was able to explain to
the doctor was what's actuallyhappening.
The underlying cause of thisbehavior is that he has
obsessive thoughts.
It wasn't necessarily like amatter of he's just an
aggressive child because hewasn't.
He had obsessive thoughts.
And what was happeningbehaviorally was that he would
(33:09):
just think about something overand over and ask for it over and
over.
And every time he got a no, hewould.
become aggressive again.
So then he may stop after awhile, like, okay, I'm not going
to ask for trains for a week,but if I see a train now, here I
go for this next week, I'm goingto have a problem because I'm
going to ask to go and buy atrain and see a train near the
(33:30):
train and all of that.
And so if we could stop himfrom, if he could get over it,
right?
Like we said, no.
And then that's it.
If we could stop him.
Cause we tried on the behaviorside, we tried to get him to
like, Hey, we were evenrecording number of times he
would ask after he was told no,like tally every single time he
asked, see if we can reduce thenumber of times that he would
(33:52):
ask, right?
Like a DRL.
That's probably the only time Iever use it.
And so, and we were able to getit down to an extent, but again,
when he, whenever he would thinkabout it again, he would, he
would escalate and the intensitywas so high.
So I let the doctor know, Idon't know if this would be
appropriate, but is there amedication that would, that
(34:13):
would deal with the underlyingcause of the obsession?
Like something that you wouldgive someone for OCD instead of
something that you would givesomeone for like psychiatric,
you know?
And so the doctor was like, youknow, that does make sense.
Parents were willing to try it.
That's the medication that hewas prescribed.
And we saw, huge improvements inhis behavior because he was able
(34:34):
to tolerate no, because theobsession was, was stopped.
So, but I think that thecoordination of care to that
extent is necessary to protectchildren, you know, socially,
especially as they get older, wehave to be willing to have
conversations with every singleperson that touches the kid,
especially these kids.
And also we have to be willingto understand other diagnoses
(34:56):
outside of autism.
And also understand otherservices that can exist either
through our organizations orthat already exists in the
community that are not just forchildren with autism.
They think that's where we putourselves into a box and we're
not really providing the serviceto every child who needs it in
the way that they need itbecause we are thinking about
how to treat autism.
(35:18):
And that is limiting.
It's limiting how effective wecan be with the science and all
the different places where wecan apply the science.
to meet the needs of the kids.
SPEAKER_04 (35:30):
I really enjoyed that account of collaborative
treatment.
I mean, that can be verytime-consuming, very difficult
to achieve.
I commend you on your efforts tomaybe...
engage another camp that can bea little bit difficult to engage
that being, uh, physicians.
Was this a specialist?
Was this the child'spediatrician?
(35:51):
Do you recall?
SPEAKER_01 (35:52):
It was, um, it was a psychiatrist, a child
psychologist.
So it wasn't, or hispsychiatrist, it wasn't his
primary care, but he had had apsychiatrist dealing with his
medications for a while.
SPEAKER_04 (36:03):
That's incredible.
SPEAKER_02 (36:04):
My buddy's a psychiatrist and he talks about
how a lot of the medications areoff label for kids.
There's not a lot of on labelmedications for kids and it's
very interesting how becausewe've taken part of some of the
psychiatrist visits and how alot of times they're 15 minutes
and it's like how are thingsgoing and the parents are like
it's terrible and it's like okaywell do we need to increase the
(36:26):
medication do we need to changethe medication and i'm sitting
there thinking about it'sterrible is that just the
medication?
Uh, are we sure that that's thereason?
Could there be other stressorsin the environment?
Could the parents be respondingor not responding correctly?
Um, so it's very interestinghow, um, and I know this is
making it seem like I'manti-medication.
I'm not saying that at all.
(36:48):
Um, that's just one variable ina very multivariate situation,
but has huge side effects asthose medications are titrated
and changed.
And I just, you made me thinkabout it with your example, how
so often these things are kindof changed willy nilly, uh, With
so, so many side effects.
And maybe it's like you said,maybe even not even the right
medication or maybe it is theright medication, but the
(37:09):
parents not doing the behavioralprotocols that are recommended
by the behavioral team.
So it is.
SPEAKER_01 (37:16):
And the thing about medication, I don't, I don't
know if I'm anti-medication, butwhat I'll say is that I do
think, well, you know, ABA wouldsay rule out medical issues
first.
That's what science says.
But then at the same time, Ifeel like we should rule out
whether or not our behavior planworks before we venture into
(37:37):
medication.
Because once the child is onmedication, if the medication
works...
then we don't get to ever knowif our intervention could have
worked without medication.
So if the medication actuallyremoves the behavior from being
a problem, sure, we can teachall these skills.
But unless this family, and mostfamilies do not, but unless this
family wants their child to beon medication forever, and that
(37:58):
to be what's actually managingtheir child's behavior and the
only thing that's managing theirchild's behavior, we do have to
find out Can we see behavioralprogress without the medication?
Will the child ever be able tobe off of their medication?
And that's where it just getskind of like sticky, right?
Because we believe thatsometimes parents will medicate
(38:20):
their kids because they don'tknow what to do and they don't
have the support.
But you can send the rightbehavior analyst in there.
And I've had kids that have comeoff of their medication, right?
Where we've slowly titrated themoff their medication.
It should be the goal, right?
Yeah, absolutely.
But you have to be able tocollaborate with their doctor
and with the family to be ableto do that.
SPEAKER_02 (38:41):
Yeah, absolutely.
In my experience, medication ismost effective when I have an
individual that I'm working withthat is not able to be receptive
or accessible to the behavioraltreatment because of maybe they
have an obsessive thoughts ormaybe they're just so
overstimulated.
They're not able to even attendfor a second or they're the
(39:01):
opposite.
They're so understimulated.
They're just like checked out.
So maybe that's just my personalexperience that that's what
medication can be very useful tohelp that individual get in the
best physiological state to bereceptive to the treatment and
hope that the behavioraltreatment will take over and
then we can titrate themedication down over time.
SPEAKER_01 (39:20):
Yeah, because they're going to give it to you.
If a parent goes in and asks forthe medication, they're going to
give it to you.
It's the diagnosis that I'malways concerned about because
what are we medicating?
Are we medicating somepsychiatric issue?
Does this child haveschizophrenia and that's what
we're medicating?
Okay, that makes sense.
But if we're just medicating,you know, aggressive behavior,
(39:41):
there should be a diagnosisconnected to that outside of
autism before medications aregiven.
SPEAKER_04 (39:49):
You alluded to this.
Is there to date an autismspecific medication or are we
doing everything off labelstill?
SPEAKER_02 (39:57):
I can't speak to...
I know my psychiatrist friendsaid the majority of it's
off-label.
I don't mean that means all ofit's off-label.
SPEAKER_04 (40:04):
I'm not sure if there's been something approved
specifically for autismtreatment, to your point,
Portia.
I think that's a reallyimportant point.
I ventured into that with...
We were part of a group that wasactually an extension.
We were the ABA department atpsychiatric...
a series of psychiatric centersand clinics here in San Diego
for a little while.
(40:25):
And we did try to interface withthe psychiatrist there to some
minimal success.
Again, I think Dan alluded tothe point earlier about, you
know, we have these 15 minuteconsultations, don't necessarily
have a whole lot of time foryour guys' questions.
But again, they were receptiveto some of the experiences, we
were able to learn a little bitmore about how to help them as
(40:47):
part of the behavior service.
And then I remember venturinginto the idea of what we're
talking about, I guess, in asense is
neuropsychopharmacology, right?
Seeing the effects of amedication on the behavior,
which to your point, Portia, wedon't talk about enough.
Maybe we should talk about morein terms of phase change lines
and really understanding how themedications work.
And that's where I'll kind ofpose this question in terms of,
(41:11):
maybe teaching parents about theside effects, the therapeutic
effects, knowing that sometimesside effects can discourage a
family from using medication,but those can be behaviorally
managed as well.
The idea that therapeuticeffects should be reinforced.
If your child is now, some ofthose behaviors went away and
they're responding more, that'ssomething that we need to be
(41:32):
ready for behaviorally toprovide reinforcement and really
make it a collaborativetreatment between the behavior
and the medication.
And then maybe understandingsome pieces like, you know,
stimulant medication with regardto, say, a comorbid ADHD
diagnosis doesn't necessarilymean your child is going to sit
down and attend.
(41:52):
In fact, one of the therapeuticeffects might be that they might
move around more, in which case,are you ready to then incite the
learning process?
So I don't really have aquestion, but I think you bring
up a lot of those points thatmaybe we don't look at closely
enough.
I just happen to have a littlebit of a background in graduate
school, so I've always beeninterested in that.
(42:14):
And I remember having thisconversation with you early on
and saying, wait, so getting theprescription is one thing, the
endogenous changes is the otherthing, but even getting that
pill into your mouth, that's...
behavioral that's us yeah and wedon't even think about that
right so the idea that hey mychild's chewing on their shirt
we stopped the medication overthe weekend okay is that what
(42:37):
your psychiatrist wanted you todo because these things have to
compound there's a as an upgradetime there's you know a lot of
things that happen so anyway ijust i'll put that out there for
commentary
SPEAKER_02 (42:48):
i do have a question for you um so you talked about
the importance of collaborationof care um one thing that i've
seen in san diego and i meanwe're a pretty big city um we
theoretically have a lot ofresources but sometimes that
collaboration of care breaksdown I remember I had a 16 year
old that was constantly runningaway from the home and we would
set these contingencies and theparents would even try to you
(43:10):
know nail the windows shut andstuff like that but the
individual would be able to findways out and maybe if I was with
them longer we could have youknow, found like, you know,
short of putting them in aprison cell, like they could see
16, he'd be able to find a wayout.
So we talked to the regionalcenter here.
Um, and again, the resources forthat kind of stuff was very
(43:31):
limited.
It was kind of like, well, ifthey run away, call the cops,
but you're talking about try theways of us keeping them out of
that system.
But sometimes it seems like theresources and the care that
there's like something missingthat could be there to keep them
out of the system.
Um, But either that's we don'tknow where that is and how to
refer them there or that's notthere and it should be there.
(43:54):
Can you speak
SPEAKER_01 (43:54):
to that?
Yeah.
Sure.
I think, um, there are, thereare missing holes.
Um, there's either like the, theresource is missing or the
relationship is missing and wedon't know unless we explore the
relationship.
Right.
So, um, last year I did a kindof like a, it's a CEU event and
it was called We The People.
Um, and it was about RyanGaynor, this child who was
(44:16):
killed.
And it was like, what else couldwe have been done?
Like what was missing from this?
his family support system.
Um, because we have to startthinking like, what are the
family support systems thatexist
SPEAKER_00 (44:26):
already
SPEAKER_01 (44:27):
just in the area?
Um, and I learned so much, likeI learned that, um, They were
calling the police.
They had called the police fivetimes and the police did not
come out.
They had come out a few times,but this particular time they
didn't come out.
They referred them to psych.
So they were like taken to thehospital.
(44:47):
So they took them to thehospital.
And so on with the people, thepoint of it was collaborative.
So we had different players inthe community attend the CEU
event for a panel conversation.
And so there was a socialworker, a licensed clinical
social worker that was there.
And she was like, well, whathappens is the police will refer
(45:08):
them to the hospital.
SPEAKER_00 (45:09):
And
SPEAKER_01 (45:10):
then when we get them to the hospital, it's our
job just to get them stable andthen release them.
SPEAKER_02 (45:15):
Exactly.
SPEAKER_01 (45:16):
And I was like, okay, so what is stable?
If you give them the medicationor you just keep them in the
hospital room until the behavioris passed and then you just send
them right back with theirparents.
You don't send them with anyresources.
You don't send them with nextsteps.
You don't speak to theirbehavior team.
You just...
Send them out, stabilize themand send them out.
So it's like, wow.
So even just understanding whathappens in all of these, like
(45:40):
what happens in the chain ofevents.
So how does it get to lawenforcement?
And of course, law enforcementwas like, we do have emergency
response teams.
But number one, the emergencyresponse teams were coming out
getting hurt.
And so they didn't want to comeout anymore because they're
coming out unarmed.
coming out and getting hurtbecause they weren't they
(46:02):
weren't behaviorally trained orsupposedly they were but then
they they didn't want to do thisanymore because they were
getting hurt so um so they werelike so we just started
referring back tohospitalization well then once
that child gets off of their 5150 72 hour hold they're just
standing back with no resourcesso it's like when the child is
on the hold or in the hospitalis there um a behavior analysis
(46:26):
unit that comes to that child'sfamily and talks to them about
what they have in place and whatresources are available to them
so that when they aredischarged, the family, they can
help the family tap into thesetypes of resources.
This is even more important infamilies where the education
isn't there, the money isn'tthere, the language may not be
there, right?
(46:46):
Where you guys are in San Diego,I'm right here, so lots of
Spanish speakers.
Almost 70% of the families thatwe serve speak Spanish.
And so making sure that theresources are accessible.
And I feel like it almost seemslike everyone has a little piece
of the puzzle of a resource oreven a list of resources that
might be available to yourchild.
But there's no...
(47:06):
resource center that is sayinghey we're going to have someone
before we discharge you comefrom our behavior analysis team
or from our resource center andtalk to you about all the
resources so we have behavioranalytics services we have this
that and we're going to call youback and make sure that you are
able to tap into these resourcesbecause we know that they're
urgent at this point for yourchild right there's there's no
(47:27):
liaison it's bringing togetherall of the information in terms
of what resources already existto make sure that families I
can't even imagine Imagine howhard it would be to just have to
search the World Wide Web forwhat is available to your child
in a community where you paytaxes.
SPEAKER_02 (47:45):
Which the regional center is supposed to do that.
And they do a wonderful job, butthere's still a lot of
loopholes.
There's still a lot of holes inthat.
SPEAKER_01 (47:55):
Yeah, they also don't serve every family, right?
So they have eligibilityrequirements.
And so what if your child is noteligible for regional center
services?
But I mean, you know, they are,that removes every resource that
regional center has.
Also, we're looking at capacity.
How many of these services canregional center even get out if
(48:15):
they have a very lengthy, verygrueling process to even add new
providers to their servicedelivery line?
So it's like the providers thatare in place, there's also not
very great resources.
checks and balances for whetheror not they're able to provide
the services, whether or not theservices are quality.
(48:35):
They do a good job at surveyingwhat services are needed, but
then they limit who can providethose services.
And so because they do that, theteams that are assigned to these
kiddos, they're just overcapacity too.
So no one is really getting highquality anything because
everyone's trying, as autismcontinues to to spiral and grow
(48:56):
out of control.
There just aren't enoughproviders to provide the
services that are necessary.
And the providers that do exist,my pastor actually said
something really interesting.
He was like, the providersexist, but y'all are closed on
nights and weekends.
And that's when the kids aregetting in trouble.
SPEAKER_00 (49:13):
They're not in school.
SPEAKER_01 (49:16):
That's when they're at home with their parents
getting into things, right?
They're stealing on the weekend.
They're sneaking out of the homeafter hours.
You guys are closed.
The behavior team is unavailablebecause you guys don't have any
emergency response team.
And I was like, wow, you'reabsolutely right.
So these are service deliverylines that if we're smart, we
can find the gaps.
And from a business perspective,from an organizational
(49:36):
management perspective, we cansay well this is what's missing
how can we create it right do wehave emergency response teams
because I cringe because I seebehavioral providers say yeah
this kid needs a higher level ofservice than what we can provide
and I'm like yeah ethicallywe're supposed to do that the
clinician doesn't feel thatthey're qualified but at the
same time who's a better serviceprovider than the behavior team
(49:58):
and where are you referring himout to because there's no one
else that can really do what wedo but we get so afraid to do it
because it requires us to stepoutside of that little box that
I think aba providers want tostay inside of to be comfortable
with what they learned in theirmaster's program
SPEAKER_02 (50:12):
well that's what dr scott was talking about a couple
of episodes about his kind ofgripe with the bacb right about
that we have to have that highlevel of competency but that
really limits our ability andour scope because if we don't
have the high level ofcompetency we can't go out and
work on things and if we'retraining under somebody who's
done it that means we're justregurgitating the way that we've
done that they've done it sothat that was an interesting
(50:35):
discussion that you kind of justalluded to as well that uh One
of our previous guests broughtup.
SPEAKER_04 (50:41):
Whoa.
And this concludes part one ofour conversation with the
illustrious and ever articulatePorsche James.
Please make sure you return forpart two.
In the meantime,
SPEAKER_00 (50:52):
always analyze responsibly.
SPEAKER_03 (50:55):
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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