🚀 Mastering ABA Business & Technology: Practice Management, Data Collection, & Growth Strategies with Suzanne Juzwik, BCBA | ABA on Tap (Part II) - ABA on Tap

Episode Transcript
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SPEAKER_00 (00:00):
Welcome to ABA on Tap, where our goal is to find
the best recipe to brew thesmoothest, coldest, and best
tasting ABA around.
I'm Dan Lowry with Mike Rubio,and join us on our journey as we

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

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

SPEAKER_02 (00:54):
All right, all right, all right.
And welcome back to part twowith Suzanne Juswick.
I am your co-host, Mike Rubio.
Enjoy.

SPEAKER_00 (01:04):
So, Mike, I remember at the CPABA conference,
remember they talked about, Ithink it was at the CPABA
conference, talked aboutTRICARE.
It might have been in one of ourpodcasts, but I think it was
CPABA conference.
Somebody mentioned that TRICARErecouped, it was like 60 or 70%
of the money they paid out back,it was like, I forget how many

(01:26):
years ago, back in...
in audits and how they were likekind of proud about it.
So speaking to what you weresaying that they were kind of
proud of, which I mean, maybethat people were billing
fraudulently.
It'll put you

SPEAKER_03 (01:38):
out of

SPEAKER_00 (01:40):
business.
Yeah.
At the end of the day, I mean,that is going to put somebody
out of business.
I mean, people aren't going toget paid.
And so there's, there's bothsides of it, but that was a
crazy stat.
I heard 60 or 70% of the moneythat they paid out.
They were cooped by the end ofthe year.
I

SPEAKER_02 (01:54):
don't even know what to say about that.
I mean, I, I would believe thatit was TRICARE, sure.
That would be easy to believe.
So we've spent a good amount oftime talking about sort of the
business end, and then we'vealluded to the clinical end of
things.
I'm going to shift gears, unlessthere's anything else anybody

(02:16):
wants to bring up.
But as we were starting torecord and we were chatting a
little bit, you said the wordReddit.
which leads us immediately tothink about the backlash that
ABA is facing from a more socialvalidity perspective.
I wouldn't say it's widespreadthat it's It's very particular

(02:38):
to the neurodivergent community,I would say.
Dan and I both agree thatactually very early on in the
podcast, we started looking forthose voices.
The Chloe Everett, that was thefirst person we ever featured on
the podcast.
Because one of the reasons westarted this was to say, hey,
there's no way we bet$1,000.
There's no way we get everythingright.

(03:00):
So let's start talking aboutthis.
Let's get better at this.
But that's something that isalso...
quite a challenge, has to be achallenge for funding sources
who are mandated to reimbursefor these empirically validated,
you know, evidence-basedservices.
We spent a lot of time talkingabout that here and the

(03:20):
differences there.
But then to hear such strongdetractors, such strong voices
out there saying, hey, man, thisstuff is no good.
This stuff is evil.
This stuff is abusive.
You know, obviously for Us asclinicians, as a board certified
behavior analyst, that can bevery challenging to hear.

(03:41):
That can be downright unnerving,frustrating.
And then sometimes you take alisten to those voices and you
kind of have to go, yeah, I hearwhat you're saying.
That was something that I OnceUpon a Time did, and I'm glad to
be able to say that I stoppeddoing that for these reasons,
and those are the very reasonsyou're kind of pointing out

(04:03):
right now.
So I packed a lot into thatcomment there.
Suzanne, help us unpack it.

SPEAKER_04 (04:13):
Yeah, actually, so it's interesting, and I'll try
to keep this short because myreasoning for bringing up Reddit
was more on the BCBA side

SPEAKER_02 (04:24):
or RBT side.
But

SPEAKER_04 (04:26):
that being said, I mean, I'm new to Reddit.
I have a really big following onLinkedIn.
I'm very active on LinkedIn.
I have been active, inactive onFacebook.
I kind of just do a check-in acouple times a month.
But now my favorite socialmedias are up there with TikTok

(04:47):
and LinkedIn for professional,which I think it's hilarious
that I love TikTok, but

UNKNOWN (04:52):
I'm good there.

SPEAKER_04 (04:53):
So Reddit, I just one day was like, I think I did
a Google search because I lovedoing Google searches.
Somebody I love from the pastused to call it Google
University.
I learned a lot of informationfrom doing random Google
searches.
And I probably typed in like ABAoutside of autism therapy.

(05:14):
And one of the things that popsup is a Reddit comments.
And I was like, you know what,I've never really hung out on
Reddit.
Let me let me check it out.
So So I hop on and I type in OBMbecause I love OBM, right?
So let's see what's on here.
And I was shocked by what Ifound.
There wasn't a lot of goodinformation.
And one of the issues withReddit that I have is everyone's

(05:38):
anonymous.
And so that kind of adds to awhole new level of you're going
to get a lot of unprofessionalbehavior versus LinkedIn where
everyone can read and see whoyou are.
Okay.
So take that.
So there are a lot of trolls onReddit.
And some people who may bepretending like they're BCBAs,

(06:01):
but they are not.
And so there's that issue too.
But whatever.
That piece aside, when we'retalking about the autism
community, I will alwaysvalidate someone's personal
experience.
I am an autism advocate.
I do help parents advocate atIEP meetings and I have friends

(06:25):
who are autistic that have grownup with ABA therapy and some
have had great experiences andsome did not.
And I personally even remembermy own, I mean, I have trauma
personally at when I was in RBTbeing asked to do things from
the person who was above me thatkind of just felt wrong, right?

(06:49):
Like, And I hate this, but I wastold as a BT, we didn't have our
BTs back then, to ignore someonecrying and this kid would
tantrum and this session wouldbe two hours and he literally
would be crying and tantrumingthe entire two hours.
And all I was supposed to do wasrecord it.

SPEAKER_02 (07:12):
Like

SPEAKER_04 (07:13):
document the duration.
Yeah.

SPEAKER_02 (07:14):
I would never do that to a four-year-old.
This entire podcast right there,what you just talked about, the
blanket ignoring, the extinctionis blanket ignoring.
Probably, I would say it's thebiggest atrocity anybody's ever
committed in the name of ABA.

SPEAKER_00 (07:29):
And we've all done it.
I agree.
Absolutely.

SPEAKER_02 (07:33):
The only reason I know it's wrong is because I
went through it.
All of us that are old

SPEAKER_04 (07:36):
school, yeah, anyone who's old school ABA, this is
what we were taught in We weretaught to do these things.
And then when I became a BCBA, Istarted telling my staff to do
things differently.
Cause I just didn't feel rightwith that.
I was like, we do not pick upchildren when they're laying on
the ground tantruming.
We do not forcibly move anyone.

(07:56):
We don't touch their faces tohave them face you or look at
you.
And like, I was like, I was theBCBA that they were like, wait,
why?
Cause everyone else tells me Ishould do this.
And I was like, well, let metell you, I'm going to grab your
face and tell you to look at me.
How does that feel?
And they're pulling away.
Like you're pulling away.
You don't want me to touch you.
How do you think you're going tofeel if you're a kid and you

(08:19):
have no autonomy over your ownbody?
Like, of course they grow up tohave trauma.
Right.
And so, yes, I mean, at the endof the day, if you're practicing
ABA and you're training otherpeople, you need to be doing
trauma informed ABA,compassionate care ABA.

(08:39):
And to me, if you're not, youhave no business doing ABA
anymore.
Like that's just, that's why ABAhas a bad name, right?

SPEAKER_02 (08:48):
That is, I agree a thousand percent with what
you're saying.
I recently took a little bit ofa deep dive into some of the
older literature, you know,seven dimensions and, You think
it's difficult because there'ssome language in there that is
very archaic.
And then.
Oh, yeah.

(09:08):
Street has

SPEAKER_04 (09:09):
run in Fox toilet training.

SPEAKER_02 (09:10):
So so you get it.
And then and then you you know,I guess I bring it up because
it's it's not to say that.
That.
That isn't compassionate orinformed ABA, but.
I would say that somewhere wewent awry, somewhere this sort
of authoritarian feel that we'reworking with a quote unquote

(09:34):
disabled population.
So whatever I tell you to do isthe correct thing to do.
And if something you do annoysme, then I've got a reason to
correct it.
And because I can go back andread some of the other
literature and it's like, well,it's not like this stuff isn't
compassionate.
Again, there's words that Iwon't repeat in there that
really-

SPEAKER_04 (09:56):
It's clearly not compassionate.
Okay.
But I think it depends on whicharticles you're reading.

SPEAKER_03 (10:01):
Yeah.

SPEAKER_04 (10:03):
And who the population was.
And I know I already threw outAsrin and Fox.
But if you read that article, itis a hard article to get
through.
It is.
They worked with adults.
And they were trying to teachadults in an institution how to
be toilet trained.
The wording that they use, Iwould never...

SPEAKER_03 (10:24):
Oh, that's completely, yeah.

SPEAKER_04 (10:27):
And then some of the procedures that they use, like
overcorrection, you know, again,I would never use
overcorrection.

SPEAKER_03 (10:34):
And

SPEAKER_04 (10:36):
so I do think it depends on which article you're
looking at.
And again, call me back anytime.
I'd love to talk about this, butit's a big thing.
And I do think, like I said, youhave to, value and understand
someone's personal experience.

SPEAKER_02 (10:54):
Absolutely.
Absolutely.

SPEAKER_04 (10:57):
If someone with autism is complaining about
their personal experience withABA, don't argue with them.
Like that does no good.

SPEAKER_02 (11:03):
That's their experience.

SPEAKER_04 (11:07):
You can just say, I actually have a funny story.
One of my friends now, we met atan advocacy leadership meeting.
conference for parents um it wasactually like a several months
training and we would go everylike one or two times a month
and on day one of this trainingthat i attended in wisconsin i'm

(11:31):
sitting at a table and you knowyou kind of turn to your right
turn to your left introduceyourself talk about what you do
and i i the woman says to meshe's a speech path and an
autism mom i'm also an autismmom because everyone there was
some kind of parent of adisabled person.
And so, because it was anadvocacy training for parents.

(11:53):
And then I got excited becauseshe said she's a speech path.
And I was like, I'm a BCBA.
And she says to me right away,I'm sorry.
I was like, oh, this is loaded.
I was like, okay, well, how do Icome back from this?

(12:15):
And it's, I mean, I probablydidn't do it great back then.
But I said, like, I'm not thatkind of BCBA.
Let me try to explain myself.
Like, like, and unfortunately,you know, every state's a little
different.
Like, I live in work inWisconsin.
Now, Wisconsin's really low bossheavy.

(12:35):
I grew up in ABA in California.
I quote unquote grew up doingABA in California.
So everything there was veryPRT, play-based therapy, natural
environment.
I'd still learn structuredteaching.
And like I said, still learnsome practices I would never do
today.
But yeah.

(12:58):
having that mindset versus likewhat majority of people do here
in Wisconsin, it was like, kindof like a, I stepped back into
the past when I first moved hereand had to really fight and, and
navigate like as a practitioner,I fully believe in natural
environment teaching.
I fully believe in, you know,ascent consent and like, how do

(13:21):
I work this through, you know?

SPEAKER_00 (13:23):
Yeah.
I mean, he was obviously, youknow, the father of ABA.
But I even think, like you said,you always say, Mike, if Lovaas,
you know, he'd be turning in hisgrave.
I think so.
It's kind of like the Wrightbrothers, like the Wright that's
being like, oh, well, andplease, I'm not disagreeing with
you at all.

(13:44):
Hopefully it doesn't seem likeI'm disagreeing with you.
I'm actually very much.
You guys don't know what

SPEAKER_04 (13:48):
Lovaas is.
because you're in California.
Sorry.
I am telling you straight up,like, if you were to come out to
the Midwest where a lot oflow-blast replication sites are,
it's like a night and daydifference of how ABA is done.

SPEAKER_02 (14:04):
You're scaring me.

SPEAKER_04 (14:07):
Oh, you should be scared.

SPEAKER_00 (14:10):
You really are.
If aviation was still the Wrightbrothers, like, I feel like
we're like on biplanes andpushing planes off a cliff.
Like, I feel like that's whatpeople like, like you're saying,
that's like, it's like, yeah,that was good.
That was good back in the day.
Can we progress a little bit?

SPEAKER_02 (14:25):
Well, and that's, that's, I think that's what
we're talking about.
Right.
So the idea that you takesomething foundational or
fundamental, um, and then you,you take it out of, uh, uh, you
know, a chronological context,right.
It's like, the idea that you goto the airport and you're about
to board your flight and you'vegot you know some guy on a
bicycle on the front and theseyou know two large wings like

(14:47):
wait a minute where's the newwhere's the airplane we you know
but again without that very uhrudimentary machine we wouldn't
have these bigger things that wehave and i so i think that we've
we've done a good job of sort oftalking around that point right
so the idea that that is it isit the science that faulty is
that is faulty or is it theapplication of the science given

(15:09):
the practical practitioner orthe purveyor.
And I think we can makearguments on both sides of that.
But, you know, to sort of wrapup my point on that is, is it
does it does frustrate me to tohave to look at the
decontextualized science andthen have it be disparaged and
going, well, wait a minute, ifyou're not if you're not moving
this forward from 1971 or even1987, you know, that Lobos

(15:34):
article, if you haven't doneanything to progress it, then
it's really not on Lobosnecessarily.
I know he's got the name andhe's the one that put it out
there.
But, you know, like Dan said, Ilove saying that to people.
Man, if Lobos knew you werestill doing it that way, he
would turn over in his grave,I'm pretty sure.
Because as a scientist, he wouldhave wanted us, I firmly

(15:55):
believe, to say, here's this.
go do something else with it.
Go evolve it.
Go make a difference after, youknow, a 1964 Civil Rights Act
and then in 1971, take some ofthose new monies and set up a
young autism project in a hugeuniversity and actually progress

(16:15):
it.
Now, I do agree that when wedon't recontextualize those
things from the past, they canrun a very horrible risk and
they can look very archaic andthey can be very detrimental
despite some good intention.
So I really appreciate the waywe talked through that because
we covered a lot of groundthere.

(16:36):
So thank you.
Pass

SPEAKER_00 (16:38):
it back to

SPEAKER_02 (16:38):
you.
Yeah.

SPEAKER_04 (16:39):
Yeah, no worries.
And I mean, at the end of theday, that's where like, you
know, like you said, you reallyshould be looking at like, what
is current best practice forthis age group for this
diagnosis, whatever, right?
And even outside of our science,I know that we're not supposed
to, you know, usepseudosciences.

(16:59):
But if, you know, people whostudy child development are
saying that you shouldn't beworking on tying shoes at age
three, that the that's typicallynot a skill that's even
developed until five or six,then why are we working on it at
four with someone who has adevelopmental delay or autism?
And same like with children whoare two, why are we making them

(17:24):
sit for 30 minutes at a table,you know, and requiring them to
stay there?
Like that is not developmentallyappropriate.
And that's to me where ourscience is, Unfortunately, you
go to school as a BCBA to becomea practitioner of the science of

(17:48):
ABA,

SPEAKER_03 (17:49):
right?

SPEAKER_04 (17:50):
You do not go to school to learn about child
development unless you also hadmaybe education as your
undergrad or part of yourmaster's.
You're not learning childdevelopment.
And so we're taking these peoplewho are learning the science and
expecting them to automaticallyknow how to apply it to humans
and children, and they have noidea anything about child

(18:15):
development.
That's just faulty.
I

SPEAKER_02 (18:19):
love talking about how you can go through a 40-hour
training as an RBT.
You can pass your 40-hourcompetency exam.
And you will still not knowsquat about how to engage a
child or run a session.
Man, we have to close that gap.
I'm actually a developmentalpsychologist by training first,

(18:40):
converted to behavior analysis.
So you're speaking my language.
And I think that, I mean, we'vedone episodes on it.
I could sit and talk for anothertwo hours about so many other
examples that you're reallyhitting the nail here on the
head.
and saying, we do things justbased on this linear application
of, well, the violin said thiswas a zero, and now I'm going to

(19:03):
turn this line item on abehavior scale into an
all-encompassing goal.
And it's like, are you sure?
That's probably why you have 30goals on your treatment plan,
and you're probably only runningabout 10 of those procedures if
you're lucky, but it looksreally nice on paper, good for
you.
And it really ties back into theassessment.

(19:24):
Those are all good things.
Where is the pragmatism?
Where is the actual practicalapplication of it?
So I think you're right, whetherit's utensil use, brushing
teeth, tying shoes, all thesethings that developmentally from
a treatment perspective, ofcourse, it's going to be very
helpful as an access skill forsomebody to be able to tie their
shoes.
And then the idea that you'regoing to beat that horse into a

(19:48):
pulp just because you know goget shoes that don't have laces.
I don't know.
There's a million others.
Yeah, I was going

SPEAKER_04 (19:55):
to say,

SPEAKER_02 (19:55):
that's my thing, too.
Right.
I mean, Skechers has a wholecampaign right now, and the
fact, you don't even have tobend down to put your shoes on
anymore.
There's shoes

SPEAKER_04 (20:04):
that you can just step into.
Exactly.
And, like, the heel fixesitself.
You don't have to

SPEAKER_02 (20:07):
do anything.
I don't want to say it's theultimate answer, because it
could still be very useful foryou to learn how to tie
something.
But the idea that we're going toget stuck on that continually
because some assessment, youknow, again,

SPEAKER_00 (20:18):
yeah.
That's, like, what we weretalking about.
And what you were saying, tooSuzanne I think is interesting
because one of the presentationsat the conference they talked
about our arbitrary 80 percentof opportunities number and they
talked about how neurotypicalpeople typically don't hit that
level of achievement and wheredid we come up with that and
they came up you know theytalked about the shoe tying the
toilet and things like that andwe just arbitrarily work on this

(20:41):
goal not having any idea whatthe if we're trying to teach to
neurotypical levels what theactual neurotypical level is of
if they're doing it and thenwhat percentage of the
opportunity they're doing it.
But back to what you were, oh,sorry.
Back to what you were saying,Mike.
Oh, go ahead, Suzanne.

SPEAKER_04 (20:59):
I was going to say that's a whole nother topic too.
I mean, just goal writing ingeneral.
Yeah.
Yeah.
A whole nother day.

SPEAKER_02 (21:09):
After moderating that conference, and we've had
this discussion several times,but we, and again, I won't get
too far into it, but I thinkit's a whole...
three-part series on ABA on Tap,to say the least, because we
adopt these conventions and thentechnology to, you know, to your
point, really helpful tool, thiscut and paste thing we do.

(21:30):
And it makes things a lot more,you know, quick and you can get
your report done.
And then all of a sudden yourindividualization is eroding and
going out the window because, Imean, again, we've talked about
all these things today alreadyin terms of how much work you
actually have to do.
And that's, you know, that canbe difficult.
That can be very, verychallenging to get it all, to

(21:52):
make it all fit.
But yeah, goal writing in termsof percentage of opportunities
versus a certain level ofaccuracy versus, I mean, it's
almost like we just replicatethis language.
And at some point, yeah, itdoesn't mean anything anymore.

SPEAKER_00 (22:06):
Mike, I do want to go back though.
Yeah.
So something, kind of going backto something we all talked about
earlier, and then we definitely,this will probably be a two-part
episode.
We'll record it all today, butwe'll split it up because We've
had a lot of discussions.
I want to get to your kind ofthe new direction of Innovation
Moon.
But before we get there, Mike,you mentioned about having goal
writing basically based on theVineland and to eliminate line

(22:30):
items on the Vineland, turnsthose zeros into ones and twos
and threes.
That's an interesting, again,juxtaposition with, as we talked
about earlier, and you mentionedvalues-based ABA, Suzanne, and
standardized assessments.
What...
How are we defining success inABA and what are we teaching to?
Because I know like mygirlfriend, who's a special ed

(22:51):
teacher in California, educationis based around standardized
assessments.
So you basically teach to thosestandardized assessments because
if you get better scores, yourschool gets better money and
things like that.
So you're teaching to thestandardized assessment, which
for a special ed individual,that may be a whole different
discussion.
But my question to both of youis, So Mike, you mentioned about

(23:15):
having programming that is moreholistic than a line item on a
Vineland.
But if that's a standardizedassessment that we're teaching
to, that insurance is going tocompensate us for, whether it's
us or the general ABA public,they're going to come back to
that because that's whatcompensation's for.
I don't know if that made sense,and I'll open it up to any of
you all, but that's where mymind went.

SPEAKER_04 (23:37):
So it does.
It makes a

SPEAKER_03 (23:39):
lot of sense.

SPEAKER_04 (23:41):
Yeah, it's less that...
I mean, yes, your teacher, yousaid wife, I think.

SPEAKER_00 (23:49):
Domestic partner, technically.

SPEAKER_04 (23:52):
Domestic partner, teacher.
They do end up right now havingto do a lot of that teaching to
the test.
And I would say that ABA, somepeople, because again, they
don't have that bigger pictureof child development, that's
where you'll see us teaching toour tests too.

(24:14):
And not just the Vineland, butlike the VB MAP.
I mean, how many goals orprograms have you looked at that
literally are like, they willsay, you know, 25 words on the
EESA level one at whateveraccuracy.
And then the targets are like,goodness gracious.

(24:34):
What are the, like, dippity dog,like, I don't know, whatever
those are, right?
Zimbabwe.
And they're directly working tothat test.
That test was never meant to beworked directly to.
We're not supposed to beteaching to any of the items
directly.
We're supposed to be doing ournormal everyday incorporation of

(24:58):
those skills in naturalenvironment, natural play, and
or structured teaching, butwe're not supposed to directly
be teaching to any test.
And so Again, that does takesome finesse and some knowledge
on the part of the clinician.
And hopefully the company isproviding enrichment for their

(25:20):
BCBAs so that they know how tonot do goals that are straight
from an assessment.
And that they're then teaching,you know, this is like a little
bit of like RFT, right?
Like we're going to do someincidental learning, right?
all children have the ability tohave incidental learning.
And so if we're doing that,we're enriching the environment,

(25:42):
we're using as many teachingexamples as we can, then ideally
when you go to do thestandardized assessment in the
six months, year, whatever theschedule is, that child's gonna
make progress, ideally.
If not, that's a whole nothersubject.
And as a parent of someone whodoes have profound autism, to

(26:05):
me, You know, maintenance isalso progress.
I know that that's a hard linewith some insurance companies
that if they're not seeingprogress, they're going to do,
you know, it's not medicallynecessary anymore because the
child's not making progress.
But I would appeal that and Iwould fight that because, you
know, there are some childrenare never going to surpass

(26:27):
whatever that level is.
Are they going to make gains?
Are they going to be smallincremental gains?
Yes.
Do they have the ability tolearn?
Yes.
But Are they going to makeenough gains that the insurance
company says, yeah, that'sgreat?
Probably not.
Like some of us, our childrengrow up to be adults and they
still need services and support.

(26:48):
I know that's not what insurancewants to hear because that's
going to cost them millions ofdollars, but hopefully that's a
small percentage.
I think it's one in every fourpersons with autism has profound
autism.
And I am, I'm starting more,more on that advocacy journey.

(27:09):
I've joined the Profound AutismAlliance.
I'm a state chapter leader here,but I'm still very much learning
about that and how to advocatefor our profoundly autistic
adults and children.
So,

SPEAKER_02 (27:23):
yeah.
That is an interesting, I guessan interesting ethical quandary
that I was discussing recentlywith a colleague.
We were going through a reportand trying to address some
comments from the funding sourceAnd it was this whole question
of the levels, right?
That the violence spits out.
And this whole idea that thereviewer was saying something

(27:48):
along the lines of, well, thisclient or this person isn't
gonna, make any more progressalong these lines or the idea
that my exit criterion was whenthat reaches a moderately low as
opposed to a lower and adequatelevel from an ethical
perspective, if there's a needthat I can identify and the
person's willing to work on it,then we can provide it.

(28:11):
But of course, you have to drawsome lines to your point.
So it's an interesting ethicalquandary for me to say, or to
think of the prospect of havinga funding source, tell me number
one, No, there's no moreprogress going to be made.
Well, I beg to differ if youjust give me the time.
And then the idea that if yougive me enough time, I don't

(28:32):
know that it's necessarily theobjective to hit that new level
on the Vineland as much asensuring that the person has as
much access as possible.
is reasonable that they actuallydesire to have.
So it's, again, I don't wanna,it's easy to beat up on the
funding sources based on allthese rules.

(28:53):
I do understand where they'recoming from.
And then at the same time for usas behavior analysts, the idea
that we might have to accept thenotion that no, there's no more
progress gonna be made.
So you're no longer medicallynecessary.
That's a tough pill to swallowto say the least.

SPEAKER_04 (29:10):
I do think, yeah.
I mean, that's at the end of theday, That's where advocacy, you
have to ask, who would beresponsible for this thing?
And if the medical model isn'tresponsible for it, so
insurance-funded ABA, then whois?

(29:33):
And then is it our state and ourfederal government who's
responsible to provide thesetypes of services?
And if they are, then we need toadvocate to make sure that they
continue to do so.
And at the end of the day, wecan't just say, well, that's not
my problem.
That's not my problem.
I mean, that's what everyone'sdoing right now.
They're saying like, you know,this, Okay, well, you come to me

(29:55):
and you say you want to work onadaptive skills.
Well, guess what?
Adaptive skills aren't in themedical model.
So we're not going to work.
We're not going to approve anyadaptive skill goals.
We're seeing a lot of insurancecompanies do that.
We're not going to approve anyeducational goals, right?
So who then is responsible foreducational goals?
The school.
Who then is responsible foradaptive goals?

(30:17):
I would argue it could be theschool, but they might say, no,
it's not us.
It's somebody else.
It's somebody else's problem.
Well, everybody pushes peopleaway saying that's somebody
else's problem.
So then at the end of the day,this is where advocacy is so
important.
And if more BCBAs want to doadvocacy, please contact me.

(30:40):
State level is very importantbecause we need parents and
providers to advocate togetherto make sure that it does become
someone's problem.
Because somebody needs to payfor it.
These services are needed.
They're needed long term.
They're needed into life or likethroughout the life of some
individuals, not all.

SPEAKER_02 (31:00):
Recently had a discussion on fine motor skills.
With the same thing, well,they're going to kick this back.
Well, I didn't take this out ofthin air.
In fact, it's under the physicaldevelopment section of the very
behavior scale you're asking meto use.
And yes, I do see how theseskills would be relevant to the

(31:20):
educational setting.
But guess what?
A pencil is also relevant to thehome, as is a crayon, as is any
of these other things that nowget regarded as fine motor and
then educational.
And it's like, wait a minute.
These are life skills that aregoing to be relevant.
So again, I do understand.
why the lines are attempted orwhy the boundaries are created.

(31:42):
And then at the same time, I, asa clinician, I face a lot more
frustration at those limitationsbecause it's like, well, this
doesn't make any sense.
You're really, it feels likeexcuse making continually.
You're just finding a way.
pigeonhole my practice, and Idon't like it.
I don't appreciate it.

SPEAKER_04 (31:59):
Well, I think we don't like it because we want to
be able to work on skills acrossthe entire person, right?

SPEAKER_03 (32:08):
And

SPEAKER_04 (32:08):
as behavior analysts, We feel like we can do
that because, you know, we lookat behavior and we know how to
break it down and we know how toapply whatever we need to to
make progress.
So but at the end of the day, ifyou're working with insurance
and you're doing a medical modelABA, they're going to tell you
no, because guess what?

(32:28):
Somebody else that is in theirpurview.
So OT.
So that's where you either bringin an OT to your practice or you
collaborate once one and you doparent training so that the
parent is, you know, providingthose opportunities outside of
the OT.
The OT only see the client onehour once a week, which we all
know is not going to helplong-term, but you can do

(32:51):
collaboration.
And so that's where, again,that's your purview if you're
doing medical model.
So we can say that, don't likeit but you're getting paid to
like it by the funder

SPEAKER_00 (33:10):
not to conflict what either of you are saying but
just to pose the opposite soabsolutely you know like give us
the time and we could make thisuh you know make this achievable
for this individual medicalinsurance might be like well how
much time and how achievable andat what point do we say any
level of achievement isappropriate because that is
somebody's life?

(33:30):
Is that what we're saying is ifwe can get a little, or does
there need to be a statisticallyor medically significant?
And then how much time?
I think that's what they'resaying.
Historically in ABA, we haven'treally done a great job of
saying that.
We

SPEAKER_04 (33:43):
haven't.
I would say this is where ifyou're working with someone with
level three autism, maybe leveltwo, someone who would fall
under like, severe, profoundkind of diagnosis.
Maybe they have Down syndrome aswell, or some other clinical
diagnosis on top of autism.

(34:05):
This is where I...
I would say that you should beusing the Essentials for Living
assessment for your skills-basedassessment.
That one focuses on those, Ithink it's Essential 8 or
Essential 9.
I'm terrible.
It's been a while since I'vepersonally used it.
But it says, here are the basicskills that any human needs

(34:28):
through adulthood.
If they don't have these basiceight skills or I think it's
eight, then they're going torely on someone for the rest of
their life for everything.
Those basic eight skills, Ithink three of them or four of
them are communication based.
And then the others are thingslike being able to change their

(34:48):
clothing or handle some simplelike feeding themselves,
acquiring food.
So again, if you're looking atthe autism population aging, if
they can't you know, use thetoilet independently.
They can't find food, accessfood, or communicate that they
need food.
They're going to need someone 24hours a day to take care of

(35:09):
them.
And so to me, if you want to getinsurance on board, you're going
to do the violin, you're goingto do whatever the required
standardized assessment is, andyou can use the AFLS, or not
AFLS, I apologize, E-F-L-S,Essentials for Living.

SPEAKER_02 (35:26):
Yeah.
Okay.

SPEAKER_00 (35:27):
Mike, anything you wanted to add?

SPEAKER_02 (35:29):
No, I mean, I think, again, I think that it's quite a
dance that we're describing, andit's good to get good at it.
And I certainly agree with theneed for those definitions,
those boundaries to be set.
But it's ever interesting,right?
So the notion that you can getexited from services for being

(35:51):
too successful, and at the sametime for not being successful,
it's a Again, I get their point.
And then at the same time, it'slike, well, can we define those
timelines?
Can we achieve a standard modeof treatment in ABA and still
have it be individualized?

(36:12):
That can be a little differentif you're giving somebody a
dosage of antibiotic based onyour height, weight.
that's going to be much moreeasily quantifiable.
But I mean, I think you madethat point, Suzanne.
And I think that's the hard parthere is that, that we are trying
to fit a very individualizedmodel into a system that
otherwise needs to generalizeacross a larger population.

(36:34):
And that's, that is proving avery formidable challenge.

SPEAKER_04 (36:40):
Yeah, definitely.
And, and that, You know, again,like I said, I do think
ultimately you have to askyourself who's paying for the
service.
If back in the day, it was aparent that paid for it out of
pocket.
And so of course you would dowhatever they wanted, you know,
because they'd say, well, it'sreally important to us that they

(37:00):
know how to stand in line atDisneyland.
Well, guess what?
The medical model isn't going toapprove that.
So, you know, you have to,again, if you don't like it,
then do private pay.
You don't like it, be asolopreneur.
Like if you don't want to workin the medical model and you
don't want to work towardswhatever box that they have,

(37:22):
because again, they're going tosay that's not our
responsibility to fund you forthat, then your options to not,
not bill insurance.
You just would have to, youknow, totally change your model.
And there are lots of BCBAs thatdo that and still do private pay
or, you know, work with regionalcenters only or work with, you

(37:42):
know, you know reimbursementfrom the state because every not
all states have regional centersso yeah

SPEAKER_02 (37:50):
i'm gonna um guide us into we've had a lovely
discussion um this is probablythe first time

SPEAKER_04 (37:57):
uh

SPEAKER_02 (37:58):
We go past our time limit and I actually feel like
we can fill two episodes worth.
But I do know that at the startof our conversation, you were
alluding to ABA outside ofautism treatment and some of
your new projects.
So I want to make sure we get tothat.
Tell us a little bit about whatyou're thinking.

SPEAKER_04 (38:20):
So I kind of call myself like a serial
entrepreneur.
I always joke that if I hadmoney, I'd be like, you know,
the owner of Virgin, right?
Like he just has like so manyideas and does so many things.
I don't have money.
So, you know, I'm limited withwhat I can do.
One of the things that I have inthe last couple of years been

(38:45):
doing, again, is, you know,building communities, working
on, you you know, providingmentorship and doing coaching,
as well as doing the businessconsultation.
And so I started Launchpad,which is a private community
currently for business owners,not limited to BCBA business

(39:07):
owners or ABA business owners.
So I invite anyone who'sbasically, I like to call ABA
adjacent.
And so I've got, you know, womenwho are who own their own
billing companies andcontracting companies that are a
part of the group.
I've got, you know, someone whothat does financial coaching to

(39:31):
people who want to learn abouttheir finance, personal
finances.
So she, you know, she's aconsultant or a coach for
personal finances, but she usesABA because she's a BCBA in that
business.
And so she, I've just been kindof collecting and networking
with all these people who dodifferent things.

(39:52):
Some people that do ABA insports.
And kind of what I fell intowhen I stepped into Reddit was I
started realizing that a lot ofpeople were posting posts,
BCBAs, who were looking forsomething else to do outside of
the behavioral health treatmentfor autism right so be outside

(40:13):
of ABA therapy for autismthey're burnt out they don't
want to maybe they'rerecognizing that was never
really for them but they loveABA and I think that that's
appropriate like that's okay tosay not all of us should work
with children right like whenyou become a teacher you get to
decide if you want to work withyoung children or adults or if

(40:35):
you want to work with highschool students you know when
you become a doctor you get tospecialize in whatever type of
practice you are going tospecialize once you hit that
doctorate level in your degree.
And so finding a specialization,it's kind of I get it.
And as an autism parent and, youknow, having my own kid be on

(40:57):
waitlist, that's, again, a wholenother conversation.
Of course, there's a need forpeople to go into autism or
behavioral health treatment forautism.
Or even education, like be aBCBA in schools.
100%, please do it.
But if you're finding yourselfburnt out, you're unhappy, you

(41:18):
hate your life, and you'requestioning if you should even
be doing ABA, I think that whatyou're really questioning is,
should I be working withchildren in this intensive
therapy model with these peopleas my boss?
And maybe I should look atsomething else that I'm
passionate about.
Can I apply ABA to that and how?

(41:40):
It's so again, like we pay a lotof money to become BCBAs, right?
You have to go to grad school,you have to pay someone
typically for supervision, youknow, fieldwork, not everybody
pays, but a lot of people do.
And so to just walk away from ascience, I mean, I'm guessing
that if you went through thatprocess, you love the science of

(42:02):
ABA, like I do.

UNKNOWN (42:03):
Yeah.

SPEAKER_04 (42:04):
Maybe you don't.
Maybe then it is time toreevaluate and change your life.
But if you're one of thosepeople who's just, I'm just
tired of working in this model.
And then you think to yourself,well, what are my options?
My options are I could start myown company.
Again, don't do it unless you'rereally prepared to do because
you're going to get burnt outfrom that.

(42:24):
also, and you're going to becomeone of those angry owners who's
always mad at their employeesand their clients.
If you don't love autismtherapy, don't do autism
therapy.
So, but, you know, the otherthing is sometimes people become
solopreneurs and they just doone-to-one contracts.

(42:45):
They don't do anything withinsurance.
You know, I've got I think oneof the first episodes I ever
listened to you guys, you didKendall Rendak Samuel.
I don't know how to say hername.
I loved that episode.
I reached out to her.
She and I are friends now.
And like she does.

SPEAKER_02 (43:03):
Your neighbors.

SPEAKER_04 (43:08):
We found that out.
So yeah, someday we're going tomeet in person, but she is in
Chicago and I'm in Wisconsin.

SPEAKER_03 (43:15):
So

SPEAKER_04 (43:16):
yeah, but it's, it is huge.
And yeah, So I just am startingto recognize and I, like I said,
I love networking.
I like to think of myself kindof like as a cheerleader.
I do personally have a lot ofanxiety and that's why it's been
very hard for me to do publicspeaking like this.

(43:37):
But this last month or quarter,Thank you.
This last month or quarter, I'vebeen pushing myself to actually
like become a speaker atconferences.
I've got a couple things linedup.
And one of the things I'verecognized that I'm good at is
networking and being a peopleconnector, like helping people

(43:58):
find other people so that eitherthey can get mentorship or
experiences.
You know, there's so many BCBAsthat are doing new, exciting
applications of ABA or, youknow, they've been doing it.
People just don't know aboutthem.
Right.
You know, we've got BCBAs whoare doing health and wellness.

(44:19):
We've got BCBAs that are workingwith gerontology or the elderly,
dementia.
We've got BCBAs who, like Isaid, personal finance programs.
Just regular coaching.
There's so many otherapplications.
So just looking at like, well,how do you take the work
experience you already have andthen go and apply for a position

(44:42):
or or forge your own?
Right.
Like you might not be able tofind a position like we always
kind of joke that there's no.
there's no jobs that are lookingfor OBM specialists.
That title doesn't exist.
I would beg to say that I haveseen a few when I'm looking at

(45:04):
what jobs there are in ABA.
Sometimes I'll see OBM in atitle of a position, but it is
rare.
And so you're not putting thatyou do, you're basically having
to look at what are the types ofthings that I can do And rewrite
your resume so that it reallyfits that job that you're hoping

(45:27):
to get.
You want to be a BCBA and workin tech?
There's definitely an avenue todo that.
So, you know, whatever it is,that's kind of what I'm coming
to this road of.
We, as a field, need a way to...
really just expose what else wecan do, right?

(45:49):
Like we always joke, ABA cansave the world.
Well, we can, maybe.
We just have to figure out howto do it in practice.
So

SPEAKER_00 (45:59):
what have you found with, so you talked about some
of the different fields, healthand wellness, even finances, and
you kind of alluded to it.
Have you found that you'readvising people more to apply to
companies and say, hey, I'm aBC, are you finding more, people
to like private pay or to likekind of create their own entity

(46:20):
within that field?
Or do they need to sign up forInnovation Moon to figure out, I
don't want to give away paidsecrets for free?
What can you speak to

SPEAKER_04 (46:31):
on that?
I mean, that's kind of the funnything.
So when I started doing Redditand I started seeing all these
people who are so sad and like,just ready to throw in the
towel.
Or maybe they had already thrownin the towel, but then they were
like, what do I do now for work?
I just started saying like, hey,here's my booking link, book
with me, let's talk.

(46:53):
So I have been giving awaycoaching for free.
That being said, now I'mrecognizing that because like
I'll look at my calendar andI've got like 10 coaching calls
that I'm not getting paidanything for.
So I am going to still offerlike a free coaching, like a
discovery call, but it's goingto be 30 minutes or less.

(47:15):
And then if people want tocontinue to work with me, then
they can sign a contract and getmentorship.
That's one way.
The other way is they can joinmy community.
And again, it is a privatecommunity, so there is a fee,
but they're going to have moreaccess to me and to other BCBAs

(47:35):
who are doing unique things, youknow, readily within kind of
like, it's almost like having aprivate Facebook group, but
cooler because it's more.
app and all of that and no one'sanonymous so there's no trolls
like we get to moderate it weget to make sure people are
actually who they say they arethat they're actually supportive

(47:57):
of each other and they'reproviding value to the community
so there's two options one is towork with me or another I can
connect them to another BCBAwho's doing something different
or they could join thecommunity.
So definitely go to my websitebecause you said we're going to

(48:21):
launch this in the new year.
So by then my website will havelinks and everything.
So if they go toinnovationmoon.com, they'll be
able to find the differentoptions.
Follow me on LinkedIn.
That's definitely another way toget in contact with me because
my name is who I am.
So they can also DM me privatelythat way.

SPEAKER_00 (48:44):
I personally...
We'll put your name in the

SPEAKER_02 (48:49):
description.

SPEAKER_00 (48:49):
We'll

SPEAKER_02 (48:49):
put

SPEAKER_00 (48:49):
all these

SPEAKER_02 (48:50):
links in the description, too.
So make sure people know how toget a hold of you.
I think you've got a ton of veryvaluable resources, and this is
very exciting.
What you're describing there interms of almost throwing in the
towel, I mean, that was...
That was Dan and myself 10months ago kind of going.
Yeah.
The way you pitched it, the wayyou quoted it too was, I mean,
it was like you were in my head.

(49:10):
I love this work.
I don't know what else I want todo for work.
This is what I'm good at.
And this is what I've been doingfor 28 years now.
I don't want to put all thatexperience aside.
So we're really, really glad tohave connected with you.
Really glad that you're doingthis for other VCBAs.
Glad to hear that you knowpeople we know.

(49:31):
I think that the community needsto become a little stronger and
start sharing more of thoseideas and start taking care of
each other.
You know, even in terms of justcoming together to create that
lobby with the insurance companyand saying, hey, can you help us
out here?
What else can you do for us?
We're trying to do good serviceand some of these constraints
are making it very difficult tomaintain that clinical quality.

(49:55):
So Dan, we're at a good stoppingpoint here.
We don't want to cut anythingoff too early, but we've covered
a lot of ground.
Anything else we want to discusshere in wrapping up?

SPEAKER_00 (50:07):
No, this is a banger.
Start the new year with them.
Yeah, thank

SPEAKER_02 (50:09):
you.

SPEAKER_00 (50:09):
Thank you, Suzanne, for your time.
And we'll hope to have you withJennifer and some other of our
regular guests back on thepodcast more regularly.

SPEAKER_02 (50:18):
Yeah,

SPEAKER_00 (50:19):
definitely.

SPEAKER_02 (50:20):
Go ahead.
Go ahead.

SPEAKER_04 (50:21):
Oh, one other plug.
I am hosting every what firstWednesday of every quarter.
So every three months, a netnetworking night, and that's
free.
So Just look again, follow me onLinkedIn, you can find the
registration, you do have toregister for it.
Right now, it'll be limited to100 people.

(50:43):
But that those networkingnights, you know, again, are a
great way to just get out thereand meet different people and
learn about how other people aredoing ABA.

SPEAKER_02 (50:53):
Cool.
So that's a good closing pointright there.
Get out there, meet otherpeople, see what other people
are doing.
Certainly find new avenues forABA and its application.
And then we'd like to close bysaying, always analyze
responsibly.
Cheers.
Thank you, Suzanne.
Thank you so much for your time.

SPEAKER_04 (51:11):
Thank you.

SPEAKER_01 (51:12):
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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🚀 Mastering ABA Business & Technology: Practice Management, Data Collection, & Growth Strategies with Suzanne Juzwik, BCBA | ABA on Tap (Part II)

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