October 5, 2025 • 52 mins
ABA on Tap is proud to present Amy Jacobs-Schroeder (Part 2 of 2):
Amy Jacobs-Schroeder is a highly respected professional in the field of Applied Behavior Analysis (ABA), and a passionate advocate for empowering parents to take an active role in their child's therapy journey. With nearly 25 years of experience in working with children with autism and other developmental disabilities, Amy brings a wealth of knowledge and expertise to the table. She obtained her Bachelor's degrees in Child Development and Psychology from California State University - Sacramento in 2001, and later a BCABA degree from the same university in 2007.
Amy is a true pioneer of the parent-led autism therapy movement, having switched to this approach 15 years ago after witnessing parents often sidelined in traditional therapy settings. This commitment led her to co-found Happy Ladders, an innovative online curriculum and coaching platform designed to empower parents of children with developmental needs, including autism, through play-based and parent-led strategies. She also shares her insights as the author of the Parent-Led Revolution blog.
Amy's dedication extends beyond her professional endeavors. She's a mother of five children and serves on the Board of Directors for Walk with Austin, a non-profit dedicated to supporting individuals with autism. Her experiences as a parent and professional have fueled her passion for making ABA therapy fun, flexible, and accessible to families worldwide, emphasizing the idea that parents are their children's best asset and should lead their developmental journey. More than anything,, Amy encourages all of you to sip slowly, enjoy your libation and ALWAYS analyze responsibly.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:10):
Welcome to ABA on TAC, 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
look back into the ingredientsto form the best concoction of
ABA on Tac.
(00:32):
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.
So without further ado, sitback, relax, and always analyze
responsibly.
SPEAKER_01 (00:52):
Alright, alright, and welcome back to yet another
installment of ABA on tap.
I am your ever grateful co-host,Mike Rubio, and this is part two
with Amy Jacobs Schroeder.
Enjoy.
And the larger the outfit, thethe more employees or RBTs or
tutors people had, the morestandardized those programs
(01:15):
became, which from a standardoperating procedure perspective
is incredible for a company.
And then it completelyobliterates the idea of
individualization at the sametime.
So again, super good intention.
And and I I think you make avery wise, uh, very astute
observation there.
It was more about how can wetrain all of these young
(01:38):
professionals to run thesesystems, and in there we can
become more efficient bypreparing their visual schedule,
preparing their token economywhether or not, or their star
chart, whether or not we thinkthe child would benefit from a
token economy.
Um so all these things becomestandardized, and at the same
time, uh the individualizationstarts going out the window.
(01:58):
That's a really good way to putit.
SPEAKER_03 (02:00):
I mean, I I trained at the first company for what,
10 years, and I remember thesecond to last day of training
was on materials, and we wouldmake the infant startup kits
where you would have the doublelaminated folder on one side
you'd have the schedule, on theother side you'd have the choice
board, you'd have the first thenstrip, like and this is what you
would you would bring in thatthat standardization.
And it it's interesting becauseyou've used the analogy of
(02:21):
McDonald's.
Um and I heard a private equityuh a private equity, an owner of
a private equity company usethat in their uh that runs the
ABA, says that that's use thatlike that's what we want to be.
We want to be the Mc uh we wantto have McDonald's, which makes
sense because like okay,anywhere I go to McDonald's, I'm
(02:42):
gonna get the same thing.
But you brought up the goodpoint is do you really want to
be the McDonald's of healthcare?
SPEAKER_04 (02:49):
Yeah.
SPEAKER_01 (02:49):
Is that is that is 30 million served?
SPEAKER_03 (02:53):
Is that is that is that what we want?
And is that is that what it is?
You brought up a good point too.
Um, Amy, I think about theparents not overrepresenting um
their kids.
Um, I think is humans werehardwired to notice what people
don't do.
You know, you ask your kid to do15 things, they do 13 of them.
You're not gonna remember the 13they do, but you're gonna really
(03:14):
remember the two that theydon't.
SPEAKER_04 (03:16):
Oh, guilty.
SPEAKER_03 (03:17):
When we would do FPAs, I can't tell you how many
times I'd ask, how does yourchild do with following
instructions?
Oh, they struggle.
Okay, what percent would you saythey follow instructions?
0%.
Really?
0% of the instructions theyfollow.
SPEAKER_05 (03:31):
It feels like, yes.
SPEAKER_03 (03:34):
Like, what if I told you I bet you money, and I've
never met you and your kid, I'dbet you they follow at least
99%.
You just don't notice it.
SPEAKER_01 (03:41):
Like, we're here, we're here to talk about their
deficits and how much serviceyou're gonna give me.
So they follow instructions,zero percent of the time.
SPEAKER_05 (03:48):
Zero percent, yeah.
So you guys are touching ongeneralization too, and I think
that's that's another, you know,and you're you uh are probably
seeing this or have seen thisalso, is this whole idea of
having to teach generalization.
Um, when if you're working in ain the middle of a family room
and you know, with some of ouractivities, yeah, there's
(04:11):
multiple people present.
Um, we have siblings, we haveolder siblings that that watch
parents implement activities,happy ladders activities, and so
they'll start doing it.
Yep.
So, because there are a lot ofthem are just little social
games, right?
It's like, you know, this theskill may be um teaching your
child to respond to look at youwhen you call their name.
So we create this cute littleactivity, this little game
(04:33):
called Hey Sarah, um, where theparent or whoever runs around
the house and hides and says,Hey Adam.
And you know, we're trying toget Adam to look.
And when Adam looks toward us,we make a big deal and we start
close to Adam and then over timewe move farther away, you know,
and so there's so muchgeneralization built into that
implementation over the fewmonths that a parent might work
(04:54):
on that skill because they'redoing it, the other parents
doing it, you know, brother,little six-year-old brother's
playing a funny game and doingit down the hallway, you know.
And so, um, and then the parentunderstands that they're trying
to get the child to respond totheir name.
So they're also calling theirname, you know, all the time.
SPEAKER_01 (05:10):
Um the way you just contextualize that is so great.
Uh, response to name is we gotrid of that program.
SPEAKER_03 (05:17):
We changed it to response to auditory stimuli.
SPEAKER_01 (05:19):
Yeah, so the idea that the joint attention, right?
So you're you have to orient tosounds, and your name is a
really important sound on thatlist of a bunch of sounds that
we would never be able toconceptualize fully, whether we
did our best task analysis ornot.
We don't know what sounds aregonna come up, but the idea that
you're gonna orient to a sound,and the way you pitch that with
(05:40):
the repetition, where it's agame, it's almost like an
expanded version of peekaboowith your name.
That's incredible.
That that is oh, I'm I'm soexcited to hear about something
like that.
Because anybody could just takethat that very simple idea and
run with it and have fun andbuild the very skill that that's
that's trying to be addressed ina way that's now jovial and
(06:03):
involves some level of of uh youknow bi-directional rapport and
exchange.
SPEAKER_03 (06:08):
Not this you know what ABA's gonna do with that in
the change in criterion, though,right?
They're gonna do it at six feetand then seven feet, and then
eight feet, and you have to doit ten times at each one before
you can move to the next footacross three supervisor or
across three tutors in twodifferent settings.
SPEAKER_01 (06:24):
Um again, another example of just so well
intended, and and then we wekind of shoot ourselves in the
foot sometimes by makingsomething um just overly
analytical, I guess, is thepoint.
SPEAKER_03 (06:36):
And then if you don't respond, you have to
prompt the response, of course.
SPEAKER_01 (06:39):
Again, these are all really super good things that we
were trained on, and then to ourconversation here, um it it's
it's conceptual.
How it actually plays out, itmay play out perfectly that way,
usually doesn't.
You usually have to adapt, youhave to pivot, you gotta shift,
you have to do something thatthen tests your conceptual
(06:59):
understanding of the conceptyou're trying to put forth and
see if you can adapt.
Again, it's that margin of errorthat that uh you know, at the
beginning of my career, almost30 years ago, yeah, it was you
know, Lovos used this table andthis chair, and they did it this
way, and this is the way you'regonna do it.
And yes, it it it worked, andthen it worked well enough that
(07:20):
it behooves us to thenrecontextualize that very
framework to bring it up tospeed, right?
And that's what you're talkingabout, Amy, is now a simple game
of where's Amy or whoever it is.
And yeah, we're playing peekaboowith sounds, uh, not just the
visual orientation, and andwe're really bringing together
both auditory and visualcomponents of joint attention.
That that's incredible,incredible.
SPEAKER_05 (07:41):
Yeah, you know where I learned a lot of that is um is
watching some of my um earlyRBTs, like my favorite RBTs, and
you guys know you've had theseRBTs that are just magic, and
they just get it, they justintuitively get it.
And when assigned a child whodoes not go by the book, yeah,
(08:06):
you know, and I've had few, Istill I'm still in contact with
the particular client I'mthinking of.
Um still friends with his mom,he's now in his 20s.
Um but he would not, I had thisbeautiful binder, beautiful
lessons, beautiful materials.
And I was like, I don't know, Iwas probably 25 years old, and
you know, here I go in.
(08:27):
I'm I'm the the you know, theprogram manager, and and I have
these two RBTs that were like myage or even older than me.
One was quite a bit older thanme.
And um, you know, I've got allthe stuff and I'm ready to go.
And this kid was like, forgetthat.
I am not sitting at that table.
(08:47):
They lived way out in thecountry.
He wanted to bounce on histrampoline all day.
And I was like, We can't youokay, so bring him back to the
table.
Right.
Like, you know, and it wasbeyond like he wasn't even gonna
tantrum if we tried, it justwasn't gonna happen.
And um, so his RBTs luckily wereincredible and they just adapted
(09:10):
and they do lessons out on thetrampoline and they try so hard
to use all my materials and runall my lessons, but pretty soon
they they like the bind, thebinder got lost somewhere in
this big old house and probablyhid it.
Um, but they taught him so muchjust through play and creating
these games for him, and heloved them.
(09:30):
And I mean, he kept these thesetutors for for quite a while
because they were just, I mean,they were so attached to him.
And and and they and that's whoI learned from.
I was supposed to be the one,you know, running this program.
And I would just, I just threwmy hands up.
Eventually, I just go out to thethis particular client's house
and just like watch them and seewhat they were teaching them
(09:50):
that day because they weren'tdoing anything that I had set
out.
SPEAKER_03 (09:55):
Was it uh oh, I'm sorry, I'm sorry, Amy.
SPEAKER_05 (09:58):
Yeah, so anyway, I've just you know, I I think
that there's there's so much tobe learned just in those those
kind of like sink or swimsituations.
You gotta figure out like how amI going to engage this child so
that they want to hang out withme so that I can, you know,
start to teach something.
SPEAKER_03 (10:15):
Yeah, I feel, and I mean, like I said, at my
previous company, my previouscompany before that, I was the
trainer, so I've probably donenew hard training for RBTs the
last 15 years.
You mentioned like it kind ofincetuous.
I feel like every RBT in SanDiego has been either trained by
me or trained by somebody who'sbeen trained the six degrees of
separation.
Um but I bring that up because Ithink it was Porsche.
(10:39):
You might remember specifically.
Um, but we had a guest onrecently that talked about how
she intentionally does not uhwhen she advertises for
positions for RBTs,intentionally does not uh put
RBT in the position and does notlook for RBTs because it they
come with like the thepredisposition of the structure
(11:01):
and all this stuff, and she'slike, I just want somebody that
can play with kids and handlebehaviors.
The rest I can teach you all therest of the stuff, but um yeah,
and that's I think what we mightactually do when we're looking
for another RBT now is we mightnot even look in the ABA field,
like we'll train you the rest,but can you play with kids?
And are you okay with behaviors?
SPEAKER_05 (11:21):
Yeah, yeah.
SPEAKER_01 (11:22):
Those RBTs you're talking about, um, you know, you
lend them a little training inthe principles of ABA or or
individuals like that, and thenyou you have to appreciate how
closely they must be payingattention to the child to be
able to figure these things out,and I think that's where we can
become overly structured.
(11:43):
Uh and I'm you know clearly I'mpartial to being a little bit
more child directed and and andyou know uh loose and working on
the incidental off of theincidentals, but um I do think
that when we come in a littletoo programmed, a little too
curriculum-based, we watch alittle bit less because now
we're insisting that the childhas to do this.
Um where if we take their lead,then we have to watch more
(12:04):
closely to turn anything intosome appropriate, you know, uh
addressing or objective towardthe target.
Um what's you know the themiddle ground?
That's what I've been trying tofigure out.
And I I do think there's a I'vebeen trying to define for myself
how far do I take thischild-directed play-based stuff
before we identify, quantifysome level of rapport, if you
(12:28):
will, uh, or instructionalcontrol that now allows me to
shift gears and go, okay,Johnny, today I'm bringing in
all this stuff, and I'm reallygonna compel you to sit next to
me.
And we should have built enoughof a relationship at this point
that I can do that again, stillmaintaining a child-directed
approach, but knowing that I'vedone this, I've I've put my time
in, I've front-loaded, so now Ican expect you to naturally sit
(12:51):
next to me and I can do thesethings that are a little bit
more structured or planned.
Um I'm still trying to definethat shifting point.
I know it happens, um, and it'shard.
It's hard to teach that.
It's hard to tell you knowyounger professionals, look,
you're gonna do this open-endedapproach for a little while, and
then the more you do this, themore you're gonna find that
child right next to you.
(13:12):
At which point, sit down and dosomething.
Sit down and do something thatyou pre-planned.
Um, you know, it it's it's hardto quantify that, but that's
what I'm after is put the timein, pay attention at first,
build that rapport truly,understand how that shifts over
into instructional control, theidea that the child is now
intrinsically motivated tointeract with you, and therefore
(13:34):
they will provide you theresponses you're looking for, or
they will provide you the uhsustained and joint attention
for you to demonstrate thoseskills that you need them to
then uh express.
So yeah.
SPEAKER_05 (13:46):
Yeah, that's a great, that's a great question.
That's a great point.
I think for me, I've always I'vealways leaned into the the
developmental skills and reallylooked at where are they
developmentally, you know, interms of what what should the
expectation be.
So if you you know have a athree-year-old client who's you
(14:08):
know scoring mainly in that sixto twelve month range, it's
gonna be really hard.
Yeah, you know, right?
That that's that that's a bigass to ask them to come sit with
you and do something structuredbecause generally that's just
that's not where they're atdevelopmentally.
Right.
Um, you know, but once you getto a point where you're more in
that like 12 to 18 month rangeand they might be like sitting
and looking at a book with youfor a few minutes and doing
(14:29):
some, you know, some pointing asyou're labeling things that you
see.
And these are some of theactivities that we have in Happy
Ladders too.
Well, now you've got you've gotyourself a little bit more of a
structured lesson, right?
You've got a child who will cometo you and sit for a minute or
two at a time and comply withsome receptive instructions.
Um, and then you can can buildfrom there.
(14:50):
But um, I think for me, that'swhy I just I always go back to
where they are, where what whatdevelopmental window are they
in?
And then then I really knowwhether or not they're they're
ready for something.
Because I think that that'ssomething that I overlooked
early in my career is you know,having kids sit at a table, like
you mentioned the table earlier.
(15:11):
Um having kids sit at a tablefor 20 minutes at a time, if
they are still in that six to 12month window, even though they
might be three or four yearsold, you're gonna see them fall
out of that chair.
unknown (15:25):
Yeah.
SPEAKER_05 (15:26):
That's what they're that you're they're not gonna
sit.
And then you're going to berunning your behavior plan
trying to get them back in thechair.
SPEAKER_01 (15:34):
That's that's a we love talking about that
particular point you just madethere.
It's like, so this behaviorhappened.
Why did it happen?
We're gonna point it back tosome sort of diagnostic trait of
non-compliance.
It had nothing to do with that.
You were having a child sit formaybe way too long, and it's
it's a tough exp, it's a toughuh it's it's a confusing
(15:54):
circumstance, right?
You just made the point.
You've got a three orfour-year-old who's of a certain
physical stature and shape whereyou can reasonably expect them
to sit and pay attention, butdevelopmentally they're 12 to 18
months.
So that's what you're gonnaexpect now a a uh motorically
capable three to four-year-oldwho can move and throw and do
(16:17):
certain things, but theirattention may not reflect that.
That's that's a tough gap.
That's where the uh you know thebehavioral part comes in.
And you're lending a much abetter understanding of that in
the way you describe it, um, andsaying these things aren't just
behavioral in nature, they'rebehavioral for us because they
seem like noncompliance orwhatever the word we're gonna
(16:37):
use, but at the same time, thisis where this child is at.
There's there's just no wayaround that.
SPEAKER_05 (16:42):
Yeah, lack of understanding and lack of of
skill.
They're just not they're notthere yet.
SPEAKER_01 (16:48):
I love the phrasing for parents, they only get older
and stronger, they only getbigger and stronger.
That's uh that's all they do.
So we gotta we gotta get thatsustained attention going now.
We gotta get some semblance ofyou know uh motoric control so
they can sit and pay attentionor uh you know follow
instructions, collaborate withyou to some extent, because they
they only get bigger andstronger.
SPEAKER_05 (17:06):
They only get yes, yes.
SPEAKER_03 (17:09):
So, Amy, question for you.
Um, kind of looking at yourwhole, I guess, career.
So you started, you were doingDTT, you were kind of pushing
the the boundary with that,moving to PRT, you found that
maybe you didn't vibe the bestwith the PRT, or maybe that had
run its course and you wanted topush past that boundary.
Um, then you started your owncompany, and then looking at the
(17:30):
hours, you um originally startedwith more hours and you wanted
to push the boundary of can wedo less hours?
Can we do tutor uh tutorlessservices?
And then now kind of pushing theboundary of moving services more
parent directed uh versustherapist directed.
Um thoughts on thoughts on thatjust in general, maybe what what
leads you to want to push thoseboundaries um rather than just
(17:53):
kind of fall into place and andhow you notice those things and
any thoughts there?
SPEAKER_05 (18:00):
Um gosh, what got me to this point?
Well, I mean, my what got me tothis point has a lot to do with
COVID.
I loved what I was doing, and Ilike I said, I um the business
that I started still exists, myprevious business partners are
still running it.
I was just ready to exit.
Um COVID kind of did that.
Um I also just had anopportunity to spend more time
(18:23):
with my own kids.
And um, as any, you know,working professional, you know,
with children understands, it'slike you're you're always you
always feel like you're failingeither at work or at home if
you're trying to do it all.
It's just hard.
It's a hard thing to manage.
And so I had the opportunity toum focus a little bit more on my
(18:44):
kids.
And so that's when I exited mymy in-home services agency, and
um, which is still alive andwell and and doing great.
That's awesome.
And um, yeah, and then it wasshortly after that that my
husband had um he he actuallyhe's in a different field in
software and he sold hisbusiness.
And so he had been um bugging mefor years to take all of this
(19:11):
online and do something with it.
And I was like, I don't evenknow what you're talking about.
I don't know how to do this.
What are you talking about?
Like we go into people's homesand work directly with kids and
parents, and I don't I don't Idon't get how I so anyway, he
talked me into it and um he andhis um business partner actually
are the ones that build the app.
(19:31):
And so um I kind of designed theapp with how my own brain works
and how I kind of tackled earlyintervention ABA programs, and
um, and then they were able tobuild the app for me.
And so that was two years ago.
Um so it kind of stumbled intoit.
I didn't really, I still I lovedwhat I was doing, um, but wanted
(19:54):
needed to have a little bit moremind share here at home.
But I think that that, you know,and and what I love about Happy
Ladders too, from a businessperspective is that it scales.
I can support, you know, I'msupporting 50 families right now
from home.
And I could never do that.
You know, if I were out workingdirectly with them, I might be
(20:17):
able to support five or 10 at atime.
And I would be driving all overthe place to do that, which is
fine, you know, and I thinkthat's and but based on kind of
the where I'm meeting thesefamilies now, I I really like um
the the support that I'm thatI'm able to give them.
And so so one thing I love, Ilove that it scales.
Um, I think we've done a lot toincrease access.
(20:38):
We're working with a lot offamilies that are in rural areas
of California that's soimportant, you know, they can't
get ABA services, they can'teven get developmental services
because they just live too farout of town, they only have one
car and you know other parentstaking that one to work.
Um and so I love that we'reable, so you know, there's a lot
of um families in ImperialCounty that are in need of um
(21:02):
developmental services and kindof early ABA services.
And so we're hoping um, youknow, through that process
through San Diego RegionalCenter to get to those families.
Our app, I forgot to mention tothe app is also available in
Spanish.
Um and then we have Spanishsupport available to families
too.
Yeah.
So um, yeah, you know, I thinkthat's that's kind of, you know,
(21:25):
my next this is, you know, my mymost recent evolution is to try
to scale and and help reach asmany families as possible.
And um, but also understandingfor the families that I have
whose child does have an autismdiagnosis or will get an autism
diagnosis, is like, what are wepreparing them for?
And I'm preparing them for, youknow, programs like yours,
(21:49):
right?
Knowing kind of what theexpectations are going to be,
what kind of support they'regoing to have available to them.
Um and I am still, I mean, I'm ahuge believer in though it might
not sound like it, but um, youknow, I believe there's a time
and a place for 40 hourprograms.
I believe there's a time and aplace for 20 hour programs.
I still think that there's atime and a place for discrete
(22:11):
trial programs.
It's not just, it shouldn't befor everybody.
It shouldn't be a blanketrecommendation for everybody.
And I think that as a field, youknow, BCBAs really need to look
at how to preserve thoseservices so that the kids that
need them the most, you know,these kids that do have profound
autism, that those families canaccess those services because
(22:34):
they need them.
I mean, they need them forsafety reasons.
SPEAKER_03 (22:37):
Yep.
SPEAKER_05 (22:37):
Um, and you know, I I see families that are going
without and and then that's youknow, we're on waiting lists and
they need something now becausethey're about to fall apart.
Um, you know, and so I thinkhopefully that's kind of the
next step in where our fieldgets um is understanding um
that, you know, this this thisjourney, this autism ABA
journey, it's a journey.
(22:58):
And what you might need at oneone point might be very
different than what you need atanother point.
And how do we make sure thatfamilies can access all those
different levels when they needthem?
unknown (23:08):
Yeah.
SPEAKER_03 (23:08):
Yeah, that's I I hope we will continue to connect
um outside of this podcastbecause I think we can both
utilize each other's services toum get get your uh you know
happy ladders across.
Um it sounds like it would be souseful to a lot of the families
that we work with.
I think I mentioned off of theum before we got on the stream
(23:28):
that, and I mentioned it too,that we've learned as much from
parent groups as they've learnedfrom us.
Um in the last couple iterationsof the parent groups, maybe the
last two or three years, one ofthe things I'm most proud of is
we made a Google Drive, uhGoogle Doc with all sorts of
resources.
So uh regional center resources,adult resources, community like
(23:49):
soccer things.
It has all the presentations wehave, all the handouts we have,
just like a depository of allthis information because a lot
of the parents would, you know,they get an autism diagnosis and
they're like, Oh, your child hasautism by.
And parents are like, uh okay,like what do I do?
Um school resources um is a bigone.
(24:10):
So I was really proud of that.
And it sounds like you know,that's kind of something that
Happy Ladders can provide aswell.
Um we also um put together apresentation.
We actually haven't delivered ityet.
Uh we got to get back in touchwith Matt.
Presentation I'm really, reallyproud of.
And again, maybe we can connectin some way, shape, or form with
it.
Um, but it's roughly about ourpresentation, and most of it
(24:32):
isn't us talking.
Um, we actually interviewed twoprevious clients, uh, the
parents of the two previousclients, and they were just
talking about their journey,about that kind of what it felt
like to get the diagnosis, wherethey went.
Now they've had services for along time.
So now, being that they've beenthe recipient of services,
looking back, what would theyadvise other parents to do and
(24:53):
not do?
Um, combines like a lot of okay,and then they're done talking.
We talk about regional center,what regional center can offer
you, what schools can offer you.
Um that presentation we're I'malso pretty proud of.
Just again, like like you'retalking about, um, giving the
parents this empowerment.
Um, I mentioned in the in theparent groups too that we used
(25:15):
to run a parent group uh onFriday mornings.
You were a part of that one,Mike.
Um, and it was three newlydiagnosed kids, and it was three
families.
Sometimes there would be afourth, but three consistent
families, and almost every weekone of the parents would be
having just a breakdown.
It would be a different parentlike every week, but just
something.
You know, one of the parents wasa single mom, two kids, um
(25:38):
barely slept, another parent hadlike three siblings, like just a
breakdown about something.
It's like if we can't give theseparents resources outside of
just ABA and saying, well,ignore your kid when your kid
cries at night, even consideringyou've had one and a half hours
of sleep and maximum you can getthree, like if we can't give
them other resources andsupports outside of it, then our
(26:00):
services are not going to beeffective.
So what you're doing, I think,really sets that tone for what
we're doing.
SPEAKER_05 (26:07):
Yeah.
Yeah, that's awesome.
Yeah, no, I I I love the idea ofum capacity, you know, and I
feel like any parent, myselfincluded, has a certain capacity
for challenges learning, right?
At any given point.
(26:28):
And I feel like a lot of ourparents who have newly diagnosed
children, their capacity isprobably at its lowest.
SPEAKER_03 (26:36):
Yep.
SPEAKER_05 (26:37):
Right.
Um, in terms of their anxiety,their stress, their worry, um,
their relationships.
SPEAKER_03 (26:44):
Yep.
Guilt maybe.
SPEAKER_05 (26:46):
Guilt oftentimes they have an infant in the home
too.
There might be a younger siblingthat's really keeping them up at
night too.
So they're just not even gettingenough sleep.
They're probably not eatingwell.
They're all all the things.
Yeah.
Right.
So their capacity is just, youknow, at its lowest.
And that's, you know, and I I dofind that a lot through our
onboarding appointments withparents is that, you know, they
(27:08):
do get on the phone and I cantell they're on the verge of
tears.
And it's like, okay, what can Igive you?
What small win can we get hereso that you feel like you've
done something?
You know, even if you can't getthe dishwasher unloaded because
you might not even be able toget that.
What small win can we get, youknow, so that you feel like,
(27:30):
okay, we're on the right track.
Um, and that may be, you know,implementing a simple activity
for two minutes a day.
Great.
That that's what you can do.
That's what you can do.
But that's where they'restarting.
And so I think, you know, thatthat idea of capacity.
And then what we see over timeis that their capacity grows.
They might just start with oneactivity.
Um, we generally have fourrecommended at any any given
(27:51):
time.
I say, start with one, just doone, you know.
But over time they start to addmore and they are running a more
robust program.
SPEAKER_03 (27:57):
So you're using ABA principles of shaping with the
parents.
Huh.
Look at that.
It's amazing how how we canutilize these things.
SPEAKER_05 (28:06):
Um yes, lots of ABA with with parents.
Yeah.
Well, yeah.
SPEAKER_01 (28:11):
I love the contrast you just made too, because I
think it's very important to saywhat you said.
There is a time and a place formore intensive 40-hour programs.
Not everybody should have it.
And then on the other end,you're saying it might be as
simple as two minutes a day ofsomething that you're doing that
you're building on.
And it's everywhere in between.
(28:31):
And I think that that uhsomewhere along the line we may
have lost sight of that, andsomewhere the fiscal health you
know takes over, and 40 hours aweek for every client sounds
very attractive and it's verypredictable, and you can run
your numbers and pay yourpeople.
Those are all good things.
And then uh, I think to yourgreater point, Amy, not
everybody's well suited forthat.
(28:53):
Even if they need it, the familymay not have the resources to
access it or the wherewithal toaccess it.
And it could be as simple as twominutes today, and then next
week we're gonna add a few moreminutes, and then we're gonna
and it's incremental.
That's that's beautifullystated.
SPEAKER_03 (29:07):
There probably still is a place for 40 hours,
although I'm pretty jaded tothat over my career.
I would I don't know, this isnot empirically validated at
all, but I would say probablyless than 10% of the clients
that are recommended 40 hoursactually need the 40 hour
services.
SPEAKER_05 (29:28):
Yeah, I mean, they're probably getting closer
to 2530, right?
Anyway, right, that would bepretty good.
Yeah, um, yeah, but you probablyhave to shoot for 40 in order to
hit 2530.
SPEAKER_03 (29:39):
Well, I okay, I was coming from a different thing.
I was saying that I think a lotof companies vastly overrecomend
services for their own needs,not necessarily the client
needs.
Um, and this kind of goes backto the other question I was
gonna ask because I think wevibe a lot on the the lower
hours.
Um, most of I don't think we'vedone more than.
(30:00):
A 12 hour week program in a longtime.
And again, not saying that thatthat not saying that there's no
client ever that needs more than12 hours a week.
But you kind of um push theboundaries with the tutor list
services and you said like fourto six hours.
Um so can you speak to maybewhere that came about?
Because that certainly wasn'tthe industry standard when you
(30:20):
did it, why you did it?
SPEAKER_05 (30:25):
Um so yeah, so that was back in like 2007.
Wow.
Um we pitched it.
We pitched the idea to our localregional center that we had
worked with.
So they trusted us.
I I actually pitched happyladders to the same group of
people like 15 years later, andI don't know that it would have
got approved because it was alsoa crazy idea.
Hey, let's do all this hairlinestuff through an app, you know,
(30:48):
and they're like, okay, which Idon't, you know, I we got very
lucky, so thank God for you knowlong-standing relationships.
SPEAKER_03 (30:56):
Absolutely.
SPEAKER_05 (30:57):
But yeah, I what motivated us to do.
SPEAKER_03 (31:02):
Where did it even come from, though?
Because fiscally for yourcompany it wouldn't be the best
thing.
So how did you come about it?
SPEAKER_05 (31:08):
We we we pushed pretty hard on a lot of that
pivotal response research.
Um, and I think that that helpedsupport our thought that four to
six hours might be enough.
Um and I think you know, we werewe were hugely, I was hugely
(31:29):
motivated to no longer employtutors.
SPEAKER_03 (31:33):
Okay, that was your motive.
Okay.
SPEAKER_05 (31:34):
Yeah, selfishly.
Um because at this point, myselfand my my two business partners
had you know started as uhtutors, worked as consultants,
supervisors, and we weredirectors at that point, you
know, at a a large agency.
And um every day was the samething.
(31:57):
You know, it was often parentscalling in mad because their
session was empty again, becausethey lost their great tutor
because we promoted the their,you know, the one tutor that
their child loved.
And it's it's you know, it'sit's funny getting on LinkedIn
and reading these stories whereI'm like, gosh, this stuff has
been happening for 20 years.
(32:18):
Right, right.
It really hasn't changed.
It's just it's just happening ona larger scale.
And we're kind of, you know,we're we're repeating a lot of
the same problems that we justhaven't been able to solve for
yet.
We have to look at some otherideas.
And once it's still saying,like, I I love the RBT role.
I think there's, you know, thereis a time and a place for
programs that are, you know,larger than 12 hours a week.
(32:42):
Um, but if we don't have to dothat, we don't need to do that,
you know, and and parents can behappier, kids can have more fun.
Um, one thing that we haven'teven really touched on is the
job is so much more enjoyablefor employees, for BCBAs, for
RBTs, you know, when we do lookat, you know, uh a less
(33:04):
intensive, more play-basedapproach, it's everyone, you
know, so then less turnover,yeah, it just solves for a lot
of that.
SPEAKER_03 (33:11):
You made that observation, I think, yesterday
when we were having the lastmeeting, our last company
meeting, you uh the observationof our cancellations versus our
previous company'scancellations.
SPEAKER_01 (33:20):
Oh, yeah, I think that probably has a lot to do
with it.
SPEAKER_03 (33:23):
And how it's so less frequently canceled at our
current company with far lesshours recommended.
And it could just be a puremetrics thing, it could just be
opportunities.
But I think even if you look atthe percentages of sessions
cancelled, it's way less.
SPEAKER_01 (33:36):
Well, and I think there's a great correlation with
that that maybe we can explorequickly, but the idea that um
our RBT gets to see us a lot,um, we are huge on parent
participation, so even ifthey're not directly uh hands-on
in the session, we're doing thesession where it's visible and
observable and they can hear itor and otherwise be a part of it
(33:57):
somehow in terms of observation.
Um and I I think that there's alot to say that if we're not
canceling and they're alwayspart of that, then I think it
cultivates uh you know a greatercontinuity.
But we should you know we shallsee.
I think uh one of our objectiveshas been redefining the RBT role
because we do think that um it'sespecially here in California,
(34:21):
it's really difficult given therange of pay, uh given uh you
know the idea that you couldmake as much money, if not more,
and have more consistency inyour hours if you go work fast
food.
Uh I don't think that many youngprofessionals went to get a
bachelor's degree to work atChick-fil-A, but if they're
paying you better than your RBTwith your psych degree, uh you
(34:42):
might go do that.
So uh yeah, I mean I I think alot of what's happening, not
just in terms of the lack ofsupport and the training, but
our big concern over the pastfew years was the RBT turnover.
You really couldn't build anycontinuity because it was two,
three weeks and before somebodyquit, or uh you were waiting for
staffing and we would have ahuge training class come in, but
(35:02):
60% of them would drop outduring training.
So it was like, well, goodriddance, because I'm glad you
did it now instead of starting acase and doing it then.
Uh but yeah, it's it's justbecome such a difficult thing to
manage.
Uh and you're right, Amy, a lotof the same problems that that
you left behind are stillhappening.
Um, and it is totally ourobjective to try and change that
(35:24):
because it is, I think it'simportant to have those young
professionals who, you know, dida psych degree, for example, to
be able to see that they can dosomething with it and that they
can actually grow in the fieldand and and learn new things.
And I mean, the idea thatsomebody could become a career
RBT, that's impossible rightnow.
We haven't made that provisionyet.
It would probably be a veryuseful um tenant for the field
(35:46):
to have somebody like a like aregistered nurse who's very
experienced and can train othernurses.
Uh but right now the assumptionis the RBT becomes the big bad
BCBA.
So somehow people are losingthat continuity no matter what,
uh, with that RBT role.
SPEAKER_05 (36:01):
Yeah, yeah.
I really love that mid-levelrole.
And I don't know how common thatis um in in your world, but we
we use the mid-levels.
Um and I I just I really likebecause the bachelor's level,
yeah, um, and or or higher.
And so there was a commitment tothe field.
(36:21):
Um and yeah, so we just saw youknow less less turnover too.
Um and the the reimbursementrate was was better.
SPEAKER_03 (36:31):
So we don't really use a mid-level, but all of our
lower level would be mid-levelequivalent, I think.
Oh so because like the mid-levelat one point was like the BC
ABA, um that level, but the theway insurance typically works,
at least with us, is you eitherhave your BCBA or you don't, you
can either build 97155 or 97153.
(36:51):
Yeah, um, so there isn't reallylike um uh a lot of value per se
in the the mid-level that we'veseen.
And please, please um correct ifwe're wrong, uh or if you see it
differently, excuse me.
Um unless maybe you're having awhole lot of inexperienced RBTs,
(37:12):
then having a more experiencedRBT to lead them.
Um, but we just typically havethe services provided either
directly by the BCBA or by amid-level equivalent.
SPEAKER_05 (37:23):
Yeah.
Yeah, it might be it might bedifferent.
Um, like I said, we worked withthe Cataly provider network.
SPEAKER_01 (37:30):
Right, sure.
Yeah, they do well with that ifI understand correctly.
And regional center makes goodprovisions for that.
I guess that second tier, if youwill.
SPEAKER_05 (37:37):
Um yeah, maybe we we built a completely different
service code with the regionalcenter, so I don't even know
what those what those uh likeABA billing codes are or or
rates anymore.
SPEAKER_01 (37:49):
So I know exactly here in San Diego, having done
early start for a little while,um, where your program is gonna
come in very uh be very usefulbecause we do have these
outlying areas here.
Um you you mentioned uh ImperialValley, we've got um so like the
Campos and Hakumba, Hamul.
(38:09):
A lot, I think there's 50 pluskids uh monthly, I would say,
from estimates that I've heard,um, who go without who have a
referral and a need forprogramming, but it's gonna be
inaccessible uh and people can'tget out to it.
So I think there's a great needthat you're gonna be able to
fill here pretty quickly and anduh we're excited for you.
SPEAKER_05 (38:29):
I hope so.
I hope so.
Well, and I would love tocontinue working with you guys
and talking to you and just on,you know, looking for
opportunities to to worktogether too.
And you mentioned your training.
I would love to look at that andpossibly put that on the app if
you feel like it'd be helpfulfor parents, um, especially
parents that are coming, youknow, that are in your area.
SPEAKER_03 (38:47):
Yeah, no.
Absolutely.
We definitely look forward to uhto collaborating.
And I I really it's veryrefreshing to talk to somebody
who's saying, like, oh, we wanttutorless services, we want less
hours.
Um that's that's something we'vefought for for a while.
And it's nice.
There are certainly people outthere.
It doesn't, it seems hard tofind them because everybody else
(39:07):
that we not everybody else, buta lot of people that we talk to
is always justifying the this iswhy we can do more hours and
more hours.
So thank you so much.
It's so refreshing.
Um, even on the parent side, Iremember at the previous
company, um, we very rarely gotcomplaints.
The only complaints we would getwould be on the front end on our
service hour recommendations.
They they'd hear that theirfriend's kid got 40 hours at
(39:30):
another service, so they wanted40 hours, not even knowing
anything about what that lookedlike, what that consisted of.
Um, so they would come inliterally before we even did the
assessment.
Will you give my kid 40 hours?
I don't know.
We haven't done an assessment.
Okay, but after you do theassessment, will you give my kid
40 hours?
And eventually it'd be like,we'll give you eight hours
direct.
If you want more hours, we'llgive them to you as parent
(39:52):
training.
Like that's we'll we'll writeyou a nice parent, we'll see you
four hours a day with parenttraining if you want.
All of a sudden they're like, uhno, I don't know if we want that
anymore.
SPEAKER_05 (40:01):
An honorary degree.
Yeah, absolutely.
SPEAKER_01 (40:04):
Well, and that's a that's an interesting point that
we keep, I think, makingindirectly uh with something
like your program, uh Amy, oryour app, you know, people are
are sort of following a guide ora curriculum for a certain
amount of time, but thatpotentiates that empowers them
to then employ or implementthose things ongoing toward that
notion of a 40 hour.
(40:25):
So instead of this becoming thisisolated treatment, which a lot
of times um you know site-basedservices run the risk of, right?
The the treatment happens here,the parents not watching, and
then we go back to that problemwith generalization.
Is it gonna happen?
Is anybody gonna do anythingoutside of the clinic outside of
these services?
But what your app does is itempowers people to always
(40:46):
consider yeah, we have theseactivities that we do, and then
I'm sure those carry over.
We're always thinking about howwe can implement these things.
And I think that's a nice way tosort of bridge that that gap.
We might only give you eight,twelve hours of service, you
know, in our case, directly aweek.
And then, yes, you'd like tomake this point, Dan.
You spend the rest of that timewith your child.
(41:08):
And often we don't do a verygood job of telling you what you
can do with your child duringthe rest of that time.
I think that's where your um appcomes in very nicely uh and
could collaborate withprogramming ongoing to tell
people, yeah, this is the thingsthat these are the things that
you do day to day.
This isn't this stop everything,set up the table and chair
intervention.
This is literallymoment-to-moment things, and
(41:30):
that's what parenting is, right?
Exactly, exactly.
It's it's it's now uh right,it's a lifestyle, it's not this
just a concentratedintervention, it's the
generality of what did I learnin that isolated moment in this
intervention, this therapeuticsetting?
And then how does that apply therest of the time in a way that's
naturalistic, open-ended, uh,you know, provides for uh
(41:53):
autonomy and agency and allthose things that um if we get
overly authoritarian in ourstyle, we we run the risk of of
stifling.
SPEAKER_03 (42:02):
So we've talked a lot about the app and kind of
around it.
Um can you talk specificallyabout where it can be found,
maybe the price point, um, thespecific features, maybe what it
looks like.
Um, so parents listening canknow all about the app, where to
find it, what it might be usefulfor specifically, the features.
(42:22):
Open the open floor for you touh talk about this app.
Uh sure.
SPEAKER_05 (42:26):
Yeah, well I'll I'll I'll keep that piece short.
Um they can go to happyladders.com to read more about
it.
I believe there's a demo on thewebsite.
Um there's also a a blog on thewebsite that I started during
COVID.
Um that that talks a lot aboutkind of the what we just talked
(42:47):
about, you know, our ourexperience, my experience and
philosophy um around therapy.
And um currently families canonly access happy ladders
through the regional centersystem.
Um so if they are, if theirchild is a regional center
client, they can um approachtheir service coordinator um
(43:08):
about happy ladders and gettingaccess to it.
And and it's it's built like amonthly um subscription.
SPEAKER_03 (43:16):
So regional center covers that or they pay for that
after it's approved.
SPEAKER_05 (43:21):
The regional center covers that, yeah.
So they they write theauthorization for you know
however many months for thefamily to have access.
Um sometimes, you know, withfamilies uh they will come into
the regional center system kindof late.
And so they might only have liketwo months eligibility with
regional center services beforetheir child ages out.
(43:43):
And here in Sacramento, they ageout at age three.
Um and um and they it dependingon whether or not they they
stay, so and that's kind of acomplicated process.
But with Happy Ladders, um, whenservice coordinators refer
families to us, the family canget access that same day.
(44:06):
So they can start programmingthat night and start, you know,
running some of these play-basedactivities, you know, at dinner
time or bedtime or bathtime.
Um what do you think?
SPEAKER_03 (44:16):
What does that look like?
Is there like a like a list ofactivities?
Okay, you've just started withus, try these activities, report
back.
Is it like where are you havingproblems?
And then it develops a programbased on that.
What does that look like?
SPEAKER_05 (44:27):
So parents, they sign up and um they there's a
few videos they they watch, afew training videos that are
really short.
Um, and then they get access tothe assessments.
And so we have um fourassessments.
We have uh communitycommunication, play, self-help,
and what we call community andcoping.
And these are all skills, theseare we're looking at
(44:48):
developmental skills across theboard.
So within those four domains,we've got um your receptive
language, your expressivelanguage, um, fine and gross
motor skills, socialization.
Pretty much everything'scovered, um, up to 36 months
old.
So in our community and copingis really like a lot of those
like community behaviors, um,transitions, things like that,
(45:12):
those early, early skills thatkids need.
Um and so parents go in and theytake these four assessments,
they check the things their kidscan do, anything that they are
not yet doing, they leave blank.
And then from there, the appcreates a personalized um plan
for their child that thenrecommends activities to target
(45:35):
the the next skill, the firstskill that they left unchecked
in each of those fourcategories.
Um there's simple activitiesthat the you know parents can
listen to the instructions, readthe instructions, whichever they
prefer.
There's a simple skillassociated with each activity.
And so they run that thatactivity.
(45:57):
They're usually they're usuallysocial games.
Um we have a lot of play skillsum too.
So a lot of a lot of stuff thatyou guys run through your
programs, right?
Um a lot of cause and effect.
We do a lot with books so thatwe can get to a point where kids
will kind of sit and look atbooks, but we got to start at
like a really small levelsometimes, just getting them to
(46:18):
sit and attend to the book forfive seconds.
And so we've got, you know, thatmay be where the activity
starts.
Um, so as kids um master eachskill, then parents say, okay,
this activity is mastered, theymark as mastered, and then the
app feeds them the next activityfor that particular area.
And they just keep movingthrough.
(46:39):
So there's some simple data thatthey can take within the app.
Um they can request support inany time, they can post
questions, they can scheduleoffice hours.
Um, there's quite a fewdifferent ways that they can get
support.
And then, like I said, we have afew other um resource library
and then also the communitywithin there.
So those that's all available,um, like I said, to regional
(47:03):
center families whose servicecoordinator puts in an
authorization.
Um, for any families that oreven families that are listening
that would like access, wealways take scholarship
families.
And so um we don't have aprivate pay set up at this
point, but for families that doreach out to us, um, we do offer
scholarships and give themaccess to the app.
(47:25):
And as long as they're using it,which we monitor um on the back
end, as long as they're usingit, they can have access to it
for however long they need.
Wow, right.
Yeah, so we have a couplefamilies.
We have a um a family out whereare they?
Are they in Illinois?
Oh wow.
Um this particular parent's beenwith us for almost two years,
(47:46):
and she's just working byherself.
Her son's been on a waiting listfor ABA this whole time.
Oh wow.
But she she has almost masteredour whole curriculum with him.
And so to me, I'm like, imaginehad she not had that, how little
progress he might have made overthe last almost two years that
(48:07):
they've been on a waiting list.
SPEAKER_01 (48:09):
So your regional center will be specific to
California, and then you'resaying you're reaching out to
people elsewhere uh from thisscholarship perspective.
When we first started talking,uh for some reason you made it
immediately made me thinkNebraska.
I always think of Nebraska as asthe state where there's there
there must be, and I'm surethere's other states in the
(48:29):
Midwest, but Nebraska wherethere must be a lot of people in
remote areas who, you know, as aservice provider, we're probably
very difficult to get to them.
But an app like yours wouldwould make that uh very
accessible.
About Alaska.
What?
About Alaska.
We've got our uh we've got ourcolleague uh our our our uh our
friend Jennifer over inKentucky.
(48:50):
Uh she might have a lot ofinterest in this.
SPEAKER_05 (48:54):
Yeah, yeah.
You know, and the other um andwe've we've talked about trying
to get into other states once weyou know continue to expand
throughout California, but um,you know, and not all states are
very tech friendly, especiallyat the state level.
You know, so um so that doestake a little bit.
(49:15):
Not everybody loves this idea ofan app or thinks that it's even
possible, you know, for it to beeffective.
And um that definitely happensthrough these state agencies,
that there's you know, peoplethat are just more resistant.
So it takes a little bit ofwork, kind of um there are some
states that are a little bitmore friendly um to tech
solutions at this point.
(49:35):
But you know, the other avenuethat I really thought would be
interesting to look at is, youknow, within all of these ABA
companies across the countrythat have waiting lists, you
know, if you're trying to givesome support and give some
momentum to families that arewaiting.
And I know in California we'renot supposed to have waiting
lists.
Um but the reality is thatthey're there.
(49:59):
They're there.
SPEAKER_01 (49:59):
Yep.
SPEAKER_05 (50:00):
So um, you know, but how can some of these ABA
agencies give, you know, theiryounger clients something, give
these families something to dowhile they wait?
Because I think that, you know,for as a parent, just having
something that you can hold onto and do with your time and
your energy so you're not justsitting and waiting.
(50:20):
Um, you know, that that wouldmake me crazy if I were a
parent.
SPEAKER_01 (50:24):
So you're good about inviting people to the parent
training groups as they wait.
I like that.
SPEAKER_03 (50:29):
Absolutely.
SPEAKER_01 (50:30):
Yeah, it's already happening, we're already giving
out information.
Just join and listen and you'rewaiting.
Yeah, that's a great idea.
I I I hope you're able to dothat.
That I think that's a reallygood idea, and maybe that's
where we'll connect um off themicrophone to see if maybe we
can help with that.
That's a that's a fantasticidea.
SPEAKER_05 (50:47):
I would love that.
I think that'd be a really cool,cool pilot to run and see.
And I would love, you know, Iselfishly, I would love to see
how those parents look once theydo start a program.
Yeah, right.
It's like what how how did howdo they look compared to parents
that that didn't have that jumpstart?
SPEAKER_01 (51:06):
Yeah.
Yep.
Well, we've covered a lot ofground.
Anything we didn't cover?
SPEAKER_03 (51:13):
Anything uh before we we wrap up that you'd like to
talk about happy ladder is thereanything anything in general
that you'd like to bring up,Amy?
SPEAKER_05 (51:21):
I can't think of anything.
I just thank you so much forthis platform.
And it's it's just it's it'sreally fun to talk with um
like-minded professionals.
Um like you said, we're a I wefeel few and far between.
I don't think we are.
SPEAKER_01 (51:39):
No.
No, we just gotta get out thereand talk to each other more.
And I think so.
We thank you for your time andfor putting out your app and and
uh for making yourselfaccessible.
SPEAKER_03 (51:48):
We will continue to collaborate for sure.
SPEAKER_05 (51:50):
Yes, I look forward to that.
SPEAKER_01 (51:52):
Wow.
So I didn't prepare my little uhmy little outro.
No, I usually prepare it.
What am I gonna say, Dan?
Help me out.
SPEAKER_03 (51:59):
Um, well, uh always involve parents.
Always involve parents.
Um well Amy's always pushed theboundaries, so you can always
push the boundaries or look toimprove.
Less is more, less is often moreand always analyze responsibly.
Cheers.
SPEAKER_05 (52:15):
Beautiful.
Thanks, guys.
Thank you.
SPEAKER_02 (52:17):
Always analyze responsibly.
SPEAKER_00 (52:20):
ABA on fat is recorded live and unfiltered.
We're done for today.
You don't have to go home, butyou can't stay here.
See you next time.
Welcome to ABA on TAC, 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
look back into the ingredientsto form the best concoction of
ABA on Tac.
(00:32):
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.
So without further ado, sitback, relax, and always analyze
responsibly.
SPEAKER_01 (00:52):
Alright, alright, and welcome back to yet another
installment of ABA on tap.
I am your ever grateful co-host,Mike Rubio, and this is part two
with Amy Jacobs Schroeder.
Enjoy.
And the larger the outfit, thethe more employees or RBTs or
tutors people had, the morestandardized those programs
(01:15):
became, which from a standardoperating procedure perspective
is incredible for a company.
And then it completelyobliterates the idea of
individualization at the sametime.
So again, super good intention.
And and I I think you make avery wise, uh, very astute
observation there.
It was more about how can wetrain all of these young
(01:38):
professionals to run thesesystems, and in there we can
become more efficient bypreparing their visual schedule,
preparing their token economywhether or not, or their star
chart, whether or not we thinkthe child would benefit from a
token economy.
Um so all these things becomestandardized, and at the same
time, uh the individualizationstarts going out the window.
(01:58):
That's a really good way to putit.
SPEAKER_03 (02:00):
I mean, I I trained at the first company for what,
10 years, and I remember thesecond to last day of training
was on materials, and we wouldmake the infant startup kits
where you would have the doublelaminated folder on one side
you'd have the schedule, on theother side you'd have the choice
board, you'd have the first thenstrip, like and this is what you
would you would bring in thatthat standardization.
And it it's interesting becauseyou've used the analogy of
(02:21):
McDonald's.
Um and I heard a private equityuh a private equity, an owner of
a private equity company usethat in their uh that runs the
ABA, says that that's use thatlike that's what we want to be.
We want to be the Mc uh we wantto have McDonald's, which makes
sense because like okay,anywhere I go to McDonald's, I'm
(02:42):
gonna get the same thing.
But you brought up the goodpoint is do you really want to
be the McDonald's of healthcare?
SPEAKER_04 (02:49):
Yeah.
SPEAKER_01 (02:49):
Is that is that is 30 million served?
SPEAKER_03 (02:53):
Is that is that is that what we want?
And is that is that what it is?
You brought up a good point too.
Um, Amy, I think about theparents not overrepresenting um
their kids.
Um, I think is humans werehardwired to notice what people
don't do.
You know, you ask your kid to do15 things, they do 13 of them.
You're not gonna remember the 13they do, but you're gonna really
(03:14):
remember the two that theydon't.
SPEAKER_04 (03:16):
Oh, guilty.
SPEAKER_03 (03:17):
When we would do FPAs, I can't tell you how many
times I'd ask, how does yourchild do with following
instructions?
Oh, they struggle.
Okay, what percent would you saythey follow instructions?
0%.
Really?
0% of the instructions theyfollow.
SPEAKER_05 (03:31):
It feels like, yes.
SPEAKER_03 (03:34):
Like, what if I told you I bet you money, and I've
never met you and your kid, I'dbet you they follow at least
99%.
You just don't notice it.
SPEAKER_01 (03:41):
Like, we're here, we're here to talk about their
deficits and how much serviceyou're gonna give me.
So they follow instructions,zero percent of the time.
SPEAKER_05 (03:48):
Zero percent, yeah.
So you guys are touching ongeneralization too, and I think
that's that's another, you know,and you're you uh are probably
seeing this or have seen thisalso, is this whole idea of
having to teach generalization.
Um, when if you're working in ain the middle of a family room
and you know, with some of ouractivities, yeah, there's
(04:11):
multiple people present.
Um, we have siblings, we haveolder siblings that that watch
parents implement activities,happy ladders activities, and so
they'll start doing it.
Yep.
So, because there are a lot ofthem are just little social
games, right?
It's like, you know, this theskill may be um teaching your
child to respond to look at youwhen you call their name.
So we create this cute littleactivity, this little game
(04:33):
called Hey Sarah, um, where theparent or whoever runs around
the house and hides and says,Hey Adam.
And you know, we're trying toget Adam to look.
And when Adam looks toward us,we make a big deal and we start
close to Adam and then over timewe move farther away, you know,
and so there's so muchgeneralization built into that
implementation over the fewmonths that a parent might work
(04:54):
on that skill because they'redoing it, the other parents
doing it, you know, brother,little six-year-old brother's
playing a funny game and doingit down the hallway, you know.
And so, um, and then the parentunderstands that they're trying
to get the child to respond totheir name.
So they're also calling theirname, you know, all the time.
SPEAKER_01 (05:10):
Um the way you just contextualize that is so great.
Uh, response to name is we gotrid of that program.
SPEAKER_03 (05:17):
We changed it to response to auditory stimuli.
SPEAKER_01 (05:19):
Yeah, so the idea that the joint attention, right?
So you're you have to orient tosounds, and your name is a
really important sound on thatlist of a bunch of sounds that
we would never be able toconceptualize fully, whether we
did our best task analysis ornot.
We don't know what sounds aregonna come up, but the idea that
you're gonna orient to a sound,and the way you pitch that with
(05:40):
the repetition, where it's agame, it's almost like an
expanded version of peekaboowith your name.
That's incredible.
That that is oh, I'm I'm soexcited to hear about something
like that.
Because anybody could just takethat that very simple idea and
run with it and have fun andbuild the very skill that that's
that's trying to be addressed ina way that's now jovial and
(06:03):
involves some level of of uh youknow bi-directional rapport and
exchange.
SPEAKER_03 (06:08):
Not this you know what ABA's gonna do with that in
the change in criterion, though,right?
They're gonna do it at six feetand then seven feet, and then
eight feet, and you have to doit ten times at each one before
you can move to the next footacross three supervisor or
across three tutors in twodifferent settings.
SPEAKER_01 (06:24):
Um again, another example of just so well
intended, and and then we wekind of shoot ourselves in the
foot sometimes by makingsomething um just overly
analytical, I guess, is thepoint.
SPEAKER_03 (06:36):
And then if you don't respond, you have to
prompt the response, of course.
SPEAKER_01 (06:39):
Again, these are all really super good things that we
were trained on, and then to ourconversation here, um it it's
it's conceptual.
How it actually plays out, itmay play out perfectly that way,
usually doesn't.
You usually have to adapt, youhave to pivot, you gotta shift,
you have to do something thatthen tests your conceptual
(06:59):
understanding of the conceptyou're trying to put forth and
see if you can adapt.
Again, it's that margin of errorthat that uh you know, at the
beginning of my career, almost30 years ago, yeah, it was you
know, Lovos used this table andthis chair, and they did it this
way, and this is the way you'regonna do it.
And yes, it it it worked, andthen it worked well enough that
(07:20):
it behooves us to thenrecontextualize that very
framework to bring it up tospeed, right?
And that's what you're talkingabout, Amy, is now a simple game
of where's Amy or whoever it is.
And yeah, we're playing peekaboowith sounds, uh, not just the
visual orientation, and andwe're really bringing together
both auditory and visualcomponents of joint attention.
That that's incredible,incredible.
SPEAKER_05 (07:41):
Yeah, you know where I learned a lot of that is um is
watching some of my um earlyRBTs, like my favorite RBTs, and
you guys know you've had theseRBTs that are just magic, and
they just get it, they justintuitively get it.
And when assigned a child whodoes not go by the book, yeah,
(08:06):
you know, and I've had few, Istill I'm still in contact with
the particular client I'mthinking of.
Um still friends with his mom,he's now in his 20s.
Um but he would not, I had thisbeautiful binder, beautiful
lessons, beautiful materials.
And I was like, I don't know, Iwas probably 25 years old, and
you know, here I go in.
(08:27):
I'm I'm the the you know, theprogram manager, and and I have
these two RBTs that were like myage or even older than me.
One was quite a bit older thanme.
And um, you know, I've got allthe stuff and I'm ready to go.
And this kid was like, forgetthat.
I am not sitting at that table.
(08:47):
They lived way out in thecountry.
He wanted to bounce on histrampoline all day.
And I was like, We can't youokay, so bring him back to the
table.
Right.
Like, you know, and it wasbeyond like he wasn't even gonna
tantrum if we tried, it justwasn't gonna happen.
And um, so his RBTs luckily wereincredible and they just adapted
(09:10):
and they do lessons out on thetrampoline and they try so hard
to use all my materials and runall my lessons, but pretty soon
they they like the bind, thebinder got lost somewhere in
this big old house and probablyhid it.
Um, but they taught him so muchjust through play and creating
these games for him, and heloved them.
(09:30):
And I mean, he kept these thesetutors for for quite a while
because they were just, I mean,they were so attached to him.
And and and they and that's whoI learned from.
I was supposed to be the one,you know, running this program.
And I would just, I just threwmy hands up.
Eventually, I just go out to thethis particular client's house
and just like watch them and seewhat they were teaching them
(09:50):
that day because they weren'tdoing anything that I had set
out.
SPEAKER_03 (09:55):
Was it uh oh, I'm sorry, I'm sorry, Amy.
SPEAKER_05 (09:58):
Yeah, so anyway, I've just you know, I I think
that there's there's so much tobe learned just in those those
kind of like sink or swimsituations.
You gotta figure out like how amI going to engage this child so
that they want to hang out withme so that I can, you know,
start to teach something.
SPEAKER_03 (10:15):
Yeah, I feel, and I mean, like I said, at my
previous company, my previouscompany before that, I was the
trainer, so I've probably donenew hard training for RBTs the
last 15 years.
You mentioned like it kind ofincetuous.
I feel like every RBT in SanDiego has been either trained by
me or trained by somebody who'sbeen trained the six degrees of
separation.
Um but I bring that up because Ithink it was Porsche.
(10:39):
You might remember specifically.
Um, but we had a guest onrecently that talked about how
she intentionally does not uhwhen she advertises for
positions for RBTs,intentionally does not uh put
RBT in the position and does notlook for RBTs because it they
come with like the thepredisposition of the structure
(11:01):
and all this stuff, and she'slike, I just want somebody that
can play with kids and handlebehaviors.
The rest I can teach you all therest of the stuff, but um yeah,
and that's I think what we mightactually do when we're looking
for another RBT now is we mightnot even look in the ABA field,
like we'll train you the rest,but can you play with kids?
And are you okay with behaviors?
SPEAKER_05 (11:21):
Yeah, yeah.
SPEAKER_01 (11:22):
Those RBTs you're talking about, um, you know, you
lend them a little training inthe principles of ABA or or
individuals like that, and thenyou you have to appreciate how
closely they must be payingattention to the child to be
able to figure these things out,and I think that's where we can
become overly structured.
(11:43):
Uh and I'm you know clearly I'mpartial to being a little bit
more child directed and and andyou know uh loose and working on
the incidental off of theincidentals, but um I do think
that when we come in a littletoo programmed, a little too
curriculum-based, we watch alittle bit less because now
we're insisting that the childhas to do this.
Um where if we take their lead,then we have to watch more
(12:04):
closely to turn anything intosome appropriate, you know, uh
addressing or objective towardthe target.
Um what's you know the themiddle ground?
That's what I've been trying tofigure out.
And I I do think there's a I'vebeen trying to define for myself
how far do I take thischild-directed play-based stuff
before we identify, quantifysome level of rapport, if you
(12:28):
will, uh, or instructionalcontrol that now allows me to
shift gears and go, okay,Johnny, today I'm bringing in
all this stuff, and I'm reallygonna compel you to sit next to
me.
And we should have built enoughof a relationship at this point
that I can do that again, stillmaintaining a child-directed
approach, but knowing that I'vedone this, I've I've put my time
in, I've front-loaded, so now Ican expect you to naturally sit
(12:51):
next to me and I can do thesethings that are a little bit
more structured or planned.
Um I'm still trying to definethat shifting point.
I know it happens, um, and it'shard.
It's hard to teach that.
It's hard to tell you knowyounger professionals, look,
you're gonna do this open-endedapproach for a little while, and
then the more you do this, themore you're gonna find that
child right next to you.
(13:12):
At which point, sit down and dosomething.
Sit down and do something thatyou pre-planned.
Um, you know, it it's it's hardto quantify that, but that's
what I'm after is put the timein, pay attention at first,
build that rapport truly,understand how that shifts over
into instructional control, theidea that the child is now
intrinsically motivated tointeract with you, and therefore
(13:34):
they will provide you theresponses you're looking for, or
they will provide you the uhsustained and joint attention
for you to demonstrate thoseskills that you need them to
then uh express.
So yeah.
SPEAKER_05 (13:46):
Yeah, that's a great, that's a great question.
That's a great point.
I think for me, I've always I'vealways leaned into the the
developmental skills and reallylooked at where are they
developmentally, you know, interms of what what should the
expectation be.
So if you you know have a athree-year-old client who's you
(14:08):
know scoring mainly in that sixto twelve month range, it's
gonna be really hard.
Yeah, you know, right?
That that's that that's a bigass to ask them to come sit with
you and do something structuredbecause generally that's just
that's not where they're atdevelopmentally.
Right.
Um, you know, but once you getto a point where you're more in
that like 12 to 18 month rangeand they might be like sitting
and looking at a book with youfor a few minutes and doing
(14:29):
some, you know, some pointing asyou're labeling things that you
see.
And these are some of theactivities that we have in Happy
Ladders too.
Well, now you've got you've gotyourself a little bit more of a
structured lesson, right?
You've got a child who will cometo you and sit for a minute or
two at a time and comply withsome receptive instructions.
Um, and then you can can buildfrom there.
(14:50):
But um, I think for me, that'swhy I just I always go back to
where they are, where what whatdevelopmental window are they
in?
And then then I really knowwhether or not they're they're
ready for something.
Because I think that that'ssomething that I overlooked
early in my career is you know,having kids sit at a table, like
you mentioned the table earlier.
(15:11):
Um having kids sit at a tablefor 20 minutes at a time, if
they are still in that six to 12month window, even though they
might be three or four yearsold, you're gonna see them fall
out of that chair.
unknown (15:25):
Yeah.
SPEAKER_05 (15:26):
That's what they're that you're they're not gonna
sit.
And then you're going to berunning your behavior plan
trying to get them back in thechair.
SPEAKER_01 (15:34):
That's that's a we love talking about that
particular point you just madethere.
It's like, so this behaviorhappened.
Why did it happen?
We're gonna point it back tosome sort of diagnostic trait of
non-compliance.
It had nothing to do with that.
You were having a child sit formaybe way too long, and it's
it's a tough exp, it's a toughuh it's it's a confusing
(15:54):
circumstance, right?
You just made the point.
You've got a three orfour-year-old who's of a certain
physical stature and shape whereyou can reasonably expect them
to sit and pay attention, butdevelopmentally they're 12 to 18
months.
So that's what you're gonnaexpect now a a uh motorically
capable three to four-year-oldwho can move and throw and do
(16:17):
certain things, but theirattention may not reflect that.
That's that's a tough gap.
That's where the uh you know thebehavioral part comes in.
And you're lending a much abetter understanding of that in
the way you describe it, um, andsaying these things aren't just
behavioral in nature, they'rebehavioral for us because they
seem like noncompliance orwhatever the word we're gonna
(16:37):
use, but at the same time, thisis where this child is at.
There's there's just no wayaround that.
SPEAKER_05 (16:42):
Yeah, lack of understanding and lack of of
skill.
They're just not they're notthere yet.
SPEAKER_01 (16:48):
I love the phrasing for parents, they only get older
and stronger, they only getbigger and stronger.
That's uh that's all they do.
So we gotta we gotta get thatsustained attention going now.
We gotta get some semblance ofyou know uh motoric control so
they can sit and pay attentionor uh you know follow
instructions, collaborate withyou to some extent, because they
they only get bigger andstronger.
SPEAKER_05 (17:06):
They only get yes, yes.
SPEAKER_03 (17:09):
So, Amy, question for you.
Um, kind of looking at yourwhole, I guess, career.
So you started, you were doingDTT, you were kind of pushing
the the boundary with that,moving to PRT, you found that
maybe you didn't vibe the bestwith the PRT, or maybe that had
run its course and you wanted topush past that boundary.
Um, then you started your owncompany, and then looking at the
(17:30):
hours, you um originally startedwith more hours and you wanted
to push the boundary of can wedo less hours?
Can we do tutor uh tutorlessservices?
And then now kind of pushing theboundary of moving services more
parent directed uh versustherapist directed.
Um thoughts on thoughts on thatjust in general, maybe what what
leads you to want to push thoseboundaries um rather than just
(17:53):
kind of fall into place and andhow you notice those things and
any thoughts there?
SPEAKER_05 (18:00):
Um gosh, what got me to this point?
Well, I mean, my what got me tothis point has a lot to do with
COVID.
I loved what I was doing, and Ilike I said, I um the business
that I started still exists, myprevious business partners are
still running it.
I was just ready to exit.
Um COVID kind of did that.
Um I also just had anopportunity to spend more time
(18:23):
with my own kids.
And um, as any, you know,working professional, you know,
with children understands, it'slike you're you're always you
always feel like you're failingeither at work or at home if
you're trying to do it all.
It's just hard.
It's a hard thing to manage.
And so I had the opportunity toum focus a little bit more on my
(18:44):
kids.
And so that's when I exited mymy in-home services agency, and
um, which is still alive andwell and and doing great.
That's awesome.
And um, yeah, and then it wasshortly after that that my
husband had um he he actuallyhe's in a different field in
software and he sold hisbusiness.
And so he had been um bugging mefor years to take all of this
(19:11):
online and do something with it.
And I was like, I don't evenknow what you're talking about.
I don't know how to do this.
What are you talking about?
Like we go into people's homesand work directly with kids and
parents, and I don't I don't Idon't get how I so anyway, he
talked me into it and um he andhis um business partner actually
are the ones that build the app.
(19:31):
And so um I kind of designed theapp with how my own brain works
and how I kind of tackled earlyintervention ABA programs, and
um, and then they were able tobuild the app for me.
And so that was two years ago.
Um so it kind of stumbled intoit.
I didn't really, I still I lovedwhat I was doing, um, but wanted
(19:54):
needed to have a little bit moremind share here at home.
But I think that that, you know,and and what I love about Happy
Ladders too, from a businessperspective is that it scales.
I can support, you know, I'msupporting 50 families right now
from home.
And I could never do that.
You know, if I were out workingdirectly with them, I might be
(20:17):
able to support five or 10 at atime.
And I would be driving all overthe place to do that, which is
fine, you know, and I thinkthat's and but based on kind of
the where I'm meeting thesefamilies now, I I really like um
the the support that I'm thatI'm able to give them.
And so so one thing I love, Ilove that it scales.
Um, I think we've done a lot toincrease access.
(20:38):
We're working with a lot offamilies that are in rural areas
of California that's soimportant, you know, they can't
get ABA services, they can'teven get developmental services
because they just live too farout of town, they only have one
car and you know other parentstaking that one to work.
Um and so I love that we'reable, so you know, there's a lot
of um families in ImperialCounty that are in need of um
(21:02):
developmental services and kindof early ABA services.
And so we're hoping um, youknow, through that process
through San Diego RegionalCenter to get to those families.
Our app, I forgot to mention tothe app is also available in
Spanish.
Um and then we have Spanishsupport available to families
too.
Yeah.
So um, yeah, you know, I thinkthat's that's kind of, you know,
(21:25):
my next this is, you know, my mymost recent evolution is to try
to scale and and help reach asmany families as possible.
And um, but also understandingfor the families that I have
whose child does have an autismdiagnosis or will get an autism
diagnosis, is like, what are wepreparing them for?
And I'm preparing them for, youknow, programs like yours,
(21:49):
right?
Knowing kind of what theexpectations are going to be,
what kind of support they'regoing to have available to them.
Um and I am still, I mean, I'm ahuge believer in though it might
not sound like it, but um, youknow, I believe there's a time
and a place for 40 hourprograms.
I believe there's a time and aplace for 20 hour programs.
I still think that there's atime and a place for discrete
(22:11):
trial programs.
It's not just, it shouldn't befor everybody.
It shouldn't be a blanketrecommendation for everybody.
And I think that as a field, youknow, BCBAs really need to look
at how to preserve thoseservices so that the kids that
need them the most, you know,these kids that do have profound
autism, that those families canaccess those services because
(22:34):
they need them.
I mean, they need them forsafety reasons.
SPEAKER_03 (22:37):
Yep.
SPEAKER_05 (22:37):
Um, and you know, I I see families that are going
without and and then that's youknow, we're on waiting lists and
they need something now becausethey're about to fall apart.
Um, you know, and so I thinkhopefully that's kind of the
next step in where our fieldgets um is understanding um
that, you know, this this thisjourney, this autism ABA
journey, it's a journey.
(22:58):
And what you might need at oneone point might be very
different than what you need atanother point.
And how do we make sure thatfamilies can access all those
different levels when they needthem?
unknown (23:08):
Yeah.
SPEAKER_03 (23:08):
Yeah, that's I I hope we will continue to connect
um outside of this podcastbecause I think we can both
utilize each other's services toum get get your uh you know
happy ladders across.
Um it sounds like it would be souseful to a lot of the families
that we work with.
I think I mentioned off of theum before we got on the stream
(23:28):
that, and I mentioned it too,that we've learned as much from
parent groups as they've learnedfrom us.
Um in the last couple iterationsof the parent groups, maybe the
last two or three years, one ofthe things I'm most proud of is
we made a Google Drive, uhGoogle Doc with all sorts of
resources.
So uh regional center resources,adult resources, community like
(23:49):
soccer things.
It has all the presentations wehave, all the handouts we have,
just like a depository of allthis information because a lot
of the parents would, you know,they get an autism diagnosis and
they're like, Oh, your child hasautism by.
And parents are like, uh okay,like what do I do?
Um school resources um is a bigone.
(24:10):
So I was really proud of that.
And it sounds like you know,that's kind of something that
Happy Ladders can provide aswell.
Um we also um put together apresentation.
We actually haven't delivered ityet.
Uh we got to get back in touchwith Matt.
Presentation I'm really, reallyproud of.
And again, maybe we can connectin some way, shape, or form with
it.
Um, but it's roughly about ourpresentation, and most of it
(24:32):
isn't us talking.
Um, we actually interviewed twoprevious clients, uh, the
parents of the two previousclients, and they were just
talking about their journey,about that kind of what it felt
like to get the diagnosis, wherethey went.
Now they've had services for along time.
So now, being that they've beenthe recipient of services,
looking back, what would theyadvise other parents to do and
(24:53):
not do?
Um, combines like a lot of okay,and then they're done talking.
We talk about regional center,what regional center can offer
you, what schools can offer you.
Um that presentation we're I'malso pretty proud of.
Just again, like like you'retalking about, um, giving the
parents this empowerment.
Um, I mentioned in the in theparent groups too that we used
(25:15):
to run a parent group uh onFriday mornings.
You were a part of that one,Mike.
Um, and it was three newlydiagnosed kids, and it was three
families.
Sometimes there would be afourth, but three consistent
families, and almost every weekone of the parents would be
having just a breakdown.
It would be a different parentlike every week, but just
something.
You know, one of the parents wasa single mom, two kids, um
(25:38):
barely slept, another parent hadlike three siblings, like just a
breakdown about something.
It's like if we can't give theseparents resources outside of
just ABA and saying, well,ignore your kid when your kid
cries at night, even consideringyou've had one and a half hours
of sleep and maximum you can getthree, like if we can't give
them other resources andsupports outside of it, then our
(26:00):
services are not going to beeffective.
So what you're doing, I think,really sets that tone for what
we're doing.
SPEAKER_05 (26:07):
Yeah.
Yeah, that's awesome.
Yeah, no, I I I love the idea ofum capacity, you know, and I
feel like any parent, myselfincluded, has a certain capacity
for challenges learning, right?
At any given point.
(26:28):
And I feel like a lot of ourparents who have newly diagnosed
children, their capacity isprobably at its lowest.
SPEAKER_03 (26:36):
Yep.
SPEAKER_05 (26:37):
Right.
Um, in terms of their anxiety,their stress, their worry, um,
their relationships.
SPEAKER_03 (26:44):
Yep.
Guilt maybe.
SPEAKER_05 (26:46):
Guilt oftentimes they have an infant in the home
too.
There might be a younger siblingthat's really keeping them up at
night too.
So they're just not even gettingenough sleep.
They're probably not eatingwell.
They're all all the things.
Yeah.
Right.
So their capacity is just, youknow, at its lowest.
And that's, you know, and I I dofind that a lot through our
onboarding appointments withparents is that, you know, they
(27:08):
do get on the phone and I cantell they're on the verge of
tears.
And it's like, okay, what can Igive you?
What small win can we get hereso that you feel like you've
done something?
You know, even if you can't getthe dishwasher unloaded because
you might not even be able toget that.
What small win can we get, youknow, so that you feel like,
(27:30):
okay, we're on the right track.
Um, and that may be, you know,implementing a simple activity
for two minutes a day.
Great.
That that's what you can do.
That's what you can do.
But that's where they'restarting.
And so I think, you know, thatthat idea of capacity.
And then what we see over timeis that their capacity grows.
They might just start with oneactivity.
Um, we generally have fourrecommended at any any given
(27:51):
time.
I say, start with one, just doone, you know.
But over time they start to addmore and they are running a more
robust program.
SPEAKER_03 (27:57):
So you're using ABA principles of shaping with the
parents.
Huh.
Look at that.
It's amazing how how we canutilize these things.
SPEAKER_05 (28:06):
Um yes, lots of ABA with with parents.
Yeah.
Well, yeah.
SPEAKER_01 (28:11):
I love the contrast you just made too, because I
think it's very important to saywhat you said.
There is a time and a place formore intensive 40-hour programs.
Not everybody should have it.
And then on the other end,you're saying it might be as
simple as two minutes a day ofsomething that you're doing that
you're building on.
And it's everywhere in between.
(28:31):
And I think that that uhsomewhere along the line we may
have lost sight of that, andsomewhere the fiscal health you
know takes over, and 40 hours aweek for every client sounds
very attractive and it's verypredictable, and you can run
your numbers and pay yourpeople.
Those are all good things.
And then uh, I think to yourgreater point, Amy, not
everybody's well suited forthat.
(28:53):
Even if they need it, the familymay not have the resources to
access it or the wherewithal toaccess it.
And it could be as simple as twominutes today, and then next
week we're gonna add a few moreminutes, and then we're gonna
and it's incremental.
That's that's beautifullystated.
SPEAKER_03 (29:07):
There probably still is a place for 40 hours,
although I'm pretty jaded tothat over my career.
I would I don't know, this isnot empirically validated at
all, but I would say probablyless than 10% of the clients
that are recommended 40 hoursactually need the 40 hour
services.
SPEAKER_05 (29:28):
Yeah, I mean, they're probably getting closer
to 2530, right?
Anyway, right, that would bepretty good.
Yeah, um, yeah, but you probablyhave to shoot for 40 in order to
hit 2530.
SPEAKER_03 (29:39):
Well, I okay, I was coming from a different thing.
I was saying that I think a lotof companies vastly overrecomend
services for their own needs,not necessarily the client
needs.
Um, and this kind of goes backto the other question I was
gonna ask because I think wevibe a lot on the the lower
hours.
Um, most of I don't think we'vedone more than.
(30:00):
A 12 hour week program in a longtime.
And again, not saying that thatthat not saying that there's no
client ever that needs more than12 hours a week.
But you kind of um push theboundaries with the tutor list
services and you said like fourto six hours.
Um so can you speak to maybewhere that came about?
Because that certainly wasn'tthe industry standard when you
(30:20):
did it, why you did it?
SPEAKER_05 (30:25):
Um so yeah, so that was back in like 2007.
Wow.
Um we pitched it.
We pitched the idea to our localregional center that we had
worked with.
So they trusted us.
I I actually pitched happyladders to the same group of
people like 15 years later, andI don't know that it would have
got approved because it was alsoa crazy idea.
Hey, let's do all this hairlinestuff through an app, you know,
(30:48):
and they're like, okay, which Idon't, you know, I we got very
lucky, so thank God for you knowlong-standing relationships.
SPEAKER_03 (30:56):
Absolutely.
SPEAKER_05 (30:57):
But yeah, I what motivated us to do.
SPEAKER_03 (31:02):
Where did it even come from, though?
Because fiscally for yourcompany it wouldn't be the best
thing.
So how did you come about it?
SPEAKER_05 (31:08):
We we we pushed pretty hard on a lot of that
pivotal response research.
Um, and I think that that helpedsupport our thought that four to
six hours might be enough.
Um and I think you know, we werewe were hugely, I was hugely
(31:29):
motivated to no longer employtutors.
SPEAKER_03 (31:33):
Okay, that was your motive.
Okay.
SPEAKER_05 (31:34):
Yeah, selfishly.
Um because at this point, myselfand my my two business partners
had you know started as uhtutors, worked as consultants,
supervisors, and we weredirectors at that point, you
know, at a a large agency.
And um every day was the samething.
(31:57):
You know, it was often parentscalling in mad because their
session was empty again, becausethey lost their great tutor
because we promoted the their,you know, the one tutor that
their child loved.
And it's it's you know, it'sit's funny getting on LinkedIn
and reading these stories whereI'm like, gosh, this stuff has
been happening for 20 years.
(32:18):
Right, right.
It really hasn't changed.
It's just it's just happening ona larger scale.
And we're kind of, you know,we're we're repeating a lot of
the same problems that we justhaven't been able to solve for
yet.
We have to look at some otherideas.
And once it's still saying,like, I I love the RBT role.
I think there's, you know, thereis a time and a place for
programs that are, you know,larger than 12 hours a week.
(32:42):
Um, but if we don't have to dothat, we don't need to do that,
you know, and and parents can behappier, kids can have more fun.
Um, one thing that we haven'teven really touched on is the
job is so much more enjoyablefor employees, for BCBAs, for
RBTs, you know, when we do lookat, you know, uh a less
(33:04):
intensive, more play-basedapproach, it's everyone, you
know, so then less turnover,yeah, it just solves for a lot
of that.
SPEAKER_03 (33:11):
You made that observation, I think, yesterday
when we were having the lastmeeting, our last company
meeting, you uh the observationof our cancellations versus our
previous company'scancellations.
SPEAKER_01 (33:20):
Oh, yeah, I think that probably has a lot to do
with it.
SPEAKER_03 (33:23):
And how it's so less frequently canceled at our
current company with far lesshours recommended.
And it could just be a puremetrics thing, it could just be
opportunities.
But I think even if you look atthe percentages of sessions
cancelled, it's way less.
SPEAKER_01 (33:36):
Well, and I think there's a great correlation with
that that maybe we can explorequickly, but the idea that um
our RBT gets to see us a lot,um, we are huge on parent
participation, so even ifthey're not directly uh hands-on
in the session, we're doing thesession where it's visible and
observable and they can hear itor and otherwise be a part of it
(33:57):
somehow in terms of observation.
Um and I I think that there's alot to say that if we're not
canceling and they're alwayspart of that, then I think it
cultivates uh you know a greatercontinuity.
But we should you know we shallsee.
I think uh one of our objectiveshas been redefining the RBT role
because we do think that um it'sespecially here in California,
(34:21):
it's really difficult given therange of pay, uh given uh you
know the idea that you couldmake as much money, if not more,
and have more consistency inyour hours if you go work fast
food.
Uh I don't think that many youngprofessionals went to get a
bachelor's degree to work atChick-fil-A, but if they're
paying you better than your RBTwith your psych degree, uh you
(34:42):
might go do that.
So uh yeah, I mean I I think alot of what's happening, not
just in terms of the lack ofsupport and the training, but
our big concern over the pastfew years was the RBT turnover.
You really couldn't build anycontinuity because it was two,
three weeks and before somebodyquit, or uh you were waiting for
staffing and we would have ahuge training class come in, but
(35:02):
60% of them would drop outduring training.
So it was like, well, goodriddance, because I'm glad you
did it now instead of starting acase and doing it then.
Uh but yeah, it's it's justbecome such a difficult thing to
manage.
Uh and you're right, Amy, a lotof the same problems that that
you left behind are stillhappening.
Um, and it is totally ourobjective to try and change that
(35:24):
because it is, I think it'simportant to have those young
professionals who, you know, dida psych degree, for example, to
be able to see that they can dosomething with it and that they
can actually grow in the fieldand and and learn new things.
And I mean, the idea thatsomebody could become a career
RBT, that's impossible rightnow.
We haven't made that provisionyet.
It would probably be a veryuseful um tenant for the field
(35:46):
to have somebody like a like aregistered nurse who's very
experienced and can train othernurses.
Uh but right now the assumptionis the RBT becomes the big bad
BCBA.
So somehow people are losingthat continuity no matter what,
uh, with that RBT role.
SPEAKER_05 (36:01):
Yeah, yeah.
I really love that mid-levelrole.
And I don't know how common thatis um in in your world, but we
we use the mid-levels.
Um and I I just I really likebecause the bachelor's level,
yeah, um, and or or higher.
And so there was a commitment tothe field.
(36:21):
Um and yeah, so we just saw youknow less less turnover too.
Um and the the reimbursementrate was was better.
SPEAKER_03 (36:31):
So we don't really use a mid-level, but all of our
lower level would be mid-levelequivalent, I think.
Oh so because like the mid-levelat one point was like the BC
ABA, um that level, but the theway insurance typically works,
at least with us, is you eitherhave your BCBA or you don't, you
can either build 97155 or 97153.
(36:51):
Yeah, um, so there isn't reallylike um uh a lot of value per se
in the the mid-level that we'veseen.
And please, please um correct ifwe're wrong, uh or if you see it
differently, excuse me.
Um unless maybe you're having awhole lot of inexperienced RBTs,
(37:12):
then having a more experiencedRBT to lead them.
Um, but we just typically havethe services provided either
directly by the BCBA or by amid-level equivalent.
SPEAKER_05 (37:23):
Yeah.
Yeah, it might be it might bedifferent.
Um, like I said, we worked withthe Cataly provider network.
SPEAKER_01 (37:30):
Right, sure.
Yeah, they do well with that ifI understand correctly.
And regional center makes goodprovisions for that.
I guess that second tier, if youwill.
SPEAKER_05 (37:37):
Um yeah, maybe we we built a completely different
service code with the regionalcenter, so I don't even know
what those what those uh likeABA billing codes are or or
rates anymore.
SPEAKER_01 (37:49):
So I know exactly here in San Diego, having done
early start for a little while,um, where your program is gonna
come in very uh be very usefulbecause we do have these
outlying areas here.
Um you you mentioned uh ImperialValley, we've got um so like the
Campos and Hakumba, Hamul.
(38:09):
A lot, I think there's 50 pluskids uh monthly, I would say,
from estimates that I've heard,um, who go without who have a
referral and a need forprogramming, but it's gonna be
inaccessible uh and people can'tget out to it.
So I think there's a great needthat you're gonna be able to
fill here pretty quickly and anduh we're excited for you.
SPEAKER_05 (38:29):
I hope so.
I hope so.
Well, and I would love tocontinue working with you guys
and talking to you and just on,you know, looking for
opportunities to to worktogether too.
And you mentioned your training.
I would love to look at that andpossibly put that on the app if
you feel like it'd be helpfulfor parents, um, especially
parents that are coming, youknow, that are in your area.
SPEAKER_03 (38:47):
Yeah, no.
Absolutely.
We definitely look forward to uhto collaborating.
And I I really it's veryrefreshing to talk to somebody
who's saying, like, oh, we wanttutorless services, we want less
hours.
Um that's that's something we'vefought for for a while.
And it's nice.
There are certainly people outthere.
It doesn't, it seems hard tofind them because everybody else
(39:07):
that we not everybody else, buta lot of people that we talk to
is always justifying the this iswhy we can do more hours and
more hours.
So thank you so much.
It's so refreshing.
Um, even on the parent side, Iremember at the previous
company, um, we very rarely gotcomplaints.
The only complaints we would getwould be on the front end on our
service hour recommendations.
They they'd hear that theirfriend's kid got 40 hours at
(39:30):
another service, so they wanted40 hours, not even knowing
anything about what that lookedlike, what that consisted of.
Um, so they would come inliterally before we even did the
assessment.
Will you give my kid 40 hours?
I don't know.
We haven't done an assessment.
Okay, but after you do theassessment, will you give my kid
40 hours?
And eventually it'd be like,we'll give you eight hours
direct.
If you want more hours, we'llgive them to you as parent
(39:52):
training.
Like that's we'll we'll writeyou a nice parent, we'll see you
four hours a day with parenttraining if you want.
All of a sudden they're like, uhno, I don't know if we want that
anymore.
SPEAKER_05 (40:01):
An honorary degree.
Yeah, absolutely.
SPEAKER_01 (40:04):
Well, and that's a that's an interesting point that
we keep, I think, makingindirectly uh with something
like your program, uh Amy, oryour app, you know, people are
are sort of following a guide ora curriculum for a certain
amount of time, but thatpotentiates that empowers them
to then employ or implementthose things ongoing toward that
notion of a 40 hour.
(40:25):
So instead of this becoming thisisolated treatment, which a lot
of times um you know site-basedservices run the risk of, right?
The the treatment happens here,the parents not watching, and
then we go back to that problemwith generalization.
Is it gonna happen?
Is anybody gonna do anythingoutside of the clinic outside of
these services?
But what your app does is itempowers people to always
(40:46):
consider yeah, we have theseactivities that we do, and then
I'm sure those carry over.
We're always thinking about howwe can implement these things.
And I think that's a nice way tosort of bridge that that gap.
We might only give you eight,twelve hours of service, you
know, in our case, directly aweek.
And then, yes, you'd like tomake this point, Dan.
You spend the rest of that timewith your child.
(41:08):
And often we don't do a verygood job of telling you what you
can do with your child duringthe rest of that time.
I think that's where your um appcomes in very nicely uh and
could collaborate withprogramming ongoing to tell
people, yeah, this is the thingsthat these are the things that
you do day to day.
This isn't this stop everything,set up the table and chair
intervention.
This is literallymoment-to-moment things, and
(41:30):
that's what parenting is, right?
Exactly, exactly.
It's it's it's now uh right,it's a lifestyle, it's not this
just a concentratedintervention, it's the
generality of what did I learnin that isolated moment in this
intervention, this therapeuticsetting?
And then how does that apply therest of the time in a way that's
naturalistic, open-ended, uh,you know, provides for uh
(41:53):
autonomy and agency and allthose things that um if we get
overly authoritarian in ourstyle, we we run the risk of of
stifling.
SPEAKER_03 (42:02):
So we've talked a lot about the app and kind of
around it.
Um can you talk specificallyabout where it can be found,
maybe the price point, um, thespecific features, maybe what it
looks like.
Um, so parents listening canknow all about the app, where to
find it, what it might be usefulfor specifically, the features.
(42:22):
Open the open floor for you touh talk about this app.
Uh sure.
SPEAKER_05 (42:26):
Yeah, well I'll I'll I'll keep that piece short.
Um they can go to happyladders.com to read more about
it.
I believe there's a demo on thewebsite.
Um there's also a a blog on thewebsite that I started during
COVID.
Um that that talks a lot aboutkind of the what we just talked
(42:47):
about, you know, our ourexperience, my experience and
philosophy um around therapy.
And um currently families canonly access happy ladders
through the regional centersystem.
Um so if they are, if theirchild is a regional center
client, they can um approachtheir service coordinator um
(43:08):
about happy ladders and gettingaccess to it.
And and it's it's built like amonthly um subscription.
SPEAKER_03 (43:16):
So regional center covers that or they pay for that
after it's approved.
SPEAKER_05 (43:21):
The regional center covers that, yeah.
So they they write theauthorization for you know
however many months for thefamily to have access.
Um sometimes, you know, withfamilies uh they will come into
the regional center system kindof late.
And so they might only have liketwo months eligibility with
regional center services beforetheir child ages out.
(43:43):
And here in Sacramento, they ageout at age three.
Um and um and they it dependingon whether or not they they
stay, so and that's kind of acomplicated process.
But with Happy Ladders, um, whenservice coordinators refer
families to us, the family canget access that same day.
(44:06):
So they can start programmingthat night and start, you know,
running some of these play-basedactivities, you know, at dinner
time or bedtime or bathtime.
Um what do you think?
SPEAKER_03 (44:16):
What does that look like?
Is there like a like a list ofactivities?
Okay, you've just started withus, try these activities, report
back.
Is it like where are you havingproblems?
And then it develops a programbased on that.
What does that look like?
SPEAKER_05 (44:27):
So parents, they sign up and um they there's a
few videos they they watch, afew training videos that are
really short.
Um, and then they get access tothe assessments.
And so we have um fourassessments.
We have uh communitycommunication, play, self-help,
and what we call community andcoping.
And these are all skills, theseare we're looking at
(44:48):
developmental skills across theboard.
So within those four domains,we've got um your receptive
language, your expressivelanguage, um, fine and gross
motor skills, socialization.
Pretty much everything'scovered, um, up to 36 months
old.
So in our community and copingis really like a lot of those
like community behaviors, um,transitions, things like that,
(45:12):
those early, early skills thatkids need.
Um and so parents go in and theytake these four assessments,
they check the things their kidscan do, anything that they are
not yet doing, they leave blank.
And then from there, the appcreates a personalized um plan
for their child that thenrecommends activities to target
(45:35):
the the next skill, the firstskill that they left unchecked
in each of those fourcategories.
Um there's simple activitiesthat the you know parents can
listen to the instructions, readthe instructions, whichever they
prefer.
There's a simple skillassociated with each activity.
And so they run that thatactivity.
(45:57):
They're usually they're usuallysocial games.
Um we have a lot of play skillsum too.
So a lot of a lot of stuff thatyou guys run through your
programs, right?
Um a lot of cause and effect.
We do a lot with books so thatwe can get to a point where kids
will kind of sit and look atbooks, but we got to start at
like a really small levelsometimes, just getting them to
(46:18):
sit and attend to the book forfive seconds.
And so we've got, you know, thatmay be where the activity
starts.
Um, so as kids um master eachskill, then parents say, okay,
this activity is mastered, theymark as mastered, and then the
app feeds them the next activityfor that particular area.
And they just keep movingthrough.
(46:39):
So there's some simple data thatthey can take within the app.
Um they can request support inany time, they can post
questions, they can scheduleoffice hours.
Um, there's quite a fewdifferent ways that they can get
support.
And then, like I said, we have afew other um resource library
and then also the communitywithin there.
So those that's all available,um, like I said, to regional
(47:03):
center families whose servicecoordinator puts in an
authorization.
Um, for any families that oreven families that are listening
that would like access, wealways take scholarship
families.
And so um we don't have aprivate pay set up at this
point, but for families that doreach out to us, um, we do offer
scholarships and give themaccess to the app.
(47:25):
And as long as they're using it,which we monitor um on the back
end, as long as they're usingit, they can have access to it
for however long they need.
Wow, right.
Yeah, so we have a couplefamilies.
We have a um a family out whereare they?
Are they in Illinois?
Oh wow.
Um this particular parent's beenwith us for almost two years,
(47:46):
and she's just working byherself.
Her son's been on a waiting listfor ABA this whole time.
Oh wow.
But she she has almost masteredour whole curriculum with him.
And so to me, I'm like, imaginehad she not had that, how little
progress he might have made overthe last almost two years that
(48:07):
they've been on a waiting list.
SPEAKER_01 (48:09):
So your regional center will be specific to
California, and then you'resaying you're reaching out to
people elsewhere uh from thisscholarship perspective.
When we first started talking,uh for some reason you made it
immediately made me thinkNebraska.
I always think of Nebraska as asthe state where there's there
there must be, and I'm surethere's other states in the
(48:29):
Midwest, but Nebraska wherethere must be a lot of people in
remote areas who, you know, as aservice provider, we're probably
very difficult to get to them.
But an app like yours wouldwould make that uh very
accessible.
About Alaska.
What?
About Alaska.
We've got our uh we've got ourcolleague uh our our our uh our
friend Jennifer over inKentucky.
(48:50):
Uh she might have a lot ofinterest in this.
SPEAKER_05 (48:54):
Yeah, yeah.
You know, and the other um andwe've we've talked about trying
to get into other states once weyou know continue to expand
throughout California, but um,you know, and not all states are
very tech friendly, especiallyat the state level.
You know, so um so that doestake a little bit.
(49:15):
Not everybody loves this idea ofan app or thinks that it's even
possible, you know, for it to beeffective.
And um that definitely happensthrough these state agencies,
that there's you know, peoplethat are just more resistant.
So it takes a little bit ofwork, kind of um there are some
states that are a little bitmore friendly um to tech
solutions at this point.
(49:35):
But you know, the other avenuethat I really thought would be
interesting to look at is, youknow, within all of these ABA
companies across the countrythat have waiting lists, you
know, if you're trying to givesome support and give some
momentum to families that arewaiting.
And I know in California we'renot supposed to have waiting
lists.
Um but the reality is thatthey're there.
(49:59):
They're there.
SPEAKER_01 (49:59):
Yep.
SPEAKER_05 (50:00):
So um, you know, but how can some of these ABA
agencies give, you know, theiryounger clients something, give
these families something to dowhile they wait?
Because I think that, you know,for as a parent, just having
something that you can hold onto and do with your time and
your energy so you're not justsitting and waiting.
(50:20):
Um, you know, that that wouldmake me crazy if I were a
parent.
SPEAKER_01 (50:24):
So you're good about inviting people to the parent
training groups as they wait.
I like that.
SPEAKER_03 (50:29):
Absolutely.
SPEAKER_01 (50:30):
Yeah, it's already happening, we're already giving
out information.
Just join and listen and you'rewaiting.
Yeah, that's a great idea.
I I I hope you're able to dothat.
That I think that's a reallygood idea, and maybe that's
where we'll connect um off themicrophone to see if maybe we
can help with that.
That's a that's a fantasticidea.
SPEAKER_05 (50:47):
I would love that.
I think that'd be a really cool,cool pilot to run and see.
And I would love, you know, Iselfishly, I would love to see
how those parents look once theydo start a program.
Yeah, right.
It's like what how how did howdo they look compared to parents
that that didn't have that jumpstart?
SPEAKER_01 (51:06):
Yeah.
Yep.
Well, we've covered a lot ofground.
Anything we didn't cover?
SPEAKER_03 (51:13):
Anything uh before we we wrap up that you'd like to
talk about happy ladder is thereanything anything in general
that you'd like to bring up,Amy?
SPEAKER_05 (51:21):
I can't think of anything.
I just thank you so much forthis platform.
And it's it's just it's it'sreally fun to talk with um
like-minded professionals.
Um like you said, we're a I wefeel few and far between.
I don't think we are.
SPEAKER_01 (51:39):
No.
No, we just gotta get out thereand talk to each other more.
And I think so.
We thank you for your time andfor putting out your app and and
uh for making yourselfaccessible.
SPEAKER_03 (51:48):
We will continue to collaborate for sure.
SPEAKER_05 (51:50):
Yes, I look forward to that.
SPEAKER_01 (51:52):
Wow.
So I didn't prepare my little uhmy little outro.
No, I usually prepare it.
What am I gonna say, Dan?
Help me out.
SPEAKER_03 (51:59):
Um, well, uh always involve parents.
Always involve parents.
Um well Amy's always pushed theboundaries, so you can always
push the boundaries or look toimprove.
Less is more, less is often moreand always analyze responsibly.
Cheers.
SPEAKER_05 (52:15):
Beautiful.
Thanks, guys.
Thank you.
SPEAKER_02 (52:17):
Always analyze responsibly.
SPEAKER_00 (52:20):
ABA on fat is recorded live and unfiltered.
We're done for today.
You don't have to go home, butyou can't stay here.
See you next time.
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