ABA Treatment: One for All and All for One
These opportunities bring about things within BCBAs that they rarely talk about in the clinic setting... feelings. Feelings of excitement and maybe even a little fear. The fear that little may change if there is difficulty connecting with the family or obtaining cooperation with treatment. There exists some uncertainty of the family's receptivity and sensitivity to corrective feedback. These covert behaviors, feelings and thoughts are kept hidden quite often on both sides at least initially but will eventually rise to the surface with the passing of time and require attention.
Although, we are not charged with the duty of quantifying and graphing these covert behaviors, we certainly are required to manage them and maintain them at normative levels with positive responses at every encounter, if possible. We have a healthy respect and understanding for concerns and fears expressed by parents. How do we minimize the influence of these covert behaviors experienced on both sides? We rely on what we know best—applied behavior analysis (ABA). ABA for the patient and for the family. As the first portion of the saying goes.. "One for all."
The first few interactions with parents and the patient are just inklings of what is to come. We have just moments to glimpse into their thought processes, personalities, and behavior. Quite often, given our backgrounds, we suspect potential functions for problem behaviors from these first encounters. On initial observations, we consider whether the patient would be a good fit for the peer groups available in the clinic. We also consider whether the parents are a good fit. Are they willing to attend parent trainings, cooperate with treatment and accept treatment recommendations? However, do we consider
whether we are a good fit for them? If not, what can we do to make sure that we are?
Just like no man is an island, neither is a patient. The way my mother says it, "No one came into this world by parachute." It's not just the patient we are treating, but the family as a unit. The recommendation then, is to apply the principles of applied behavior analysis to the entire family. Parents, if you are reading this, please do not take offense. Unless being praised, encouraged, and being given multiple opportunities to get it right is aversive to you, there is nothing to fear. My mentors are great advocates of using ABA on EVERYONE. If parents are doing wonderfully, attending parent trainings and cooperating with treatment recommendations, we praise and encourage them. If there is difficulty with attending parent trainings or there are constraints which limit compliance with treatment recommendations, we create the environment and the opportunity for parents to speak freely and openly about their limitations in order to find the most accommodating solutions.
Domonique Randall, BCBA-D told me, "You must be flexible." I don't forget corrective feedback. It usually takes one occurrence, especially when it comes from the CEO of the company, for me to change my behavior. Parents, if your interaction with a BCBA has not produced the expected outcomes, consider requesting some flexibility with programming to work on items that would help meet those needs. Revisiting expectations and goals may be required. There is a place for rigidity in protocols, but give and take is part of all relationships, including the relationship between the BCBA and his or her clients.
I often ask parents during parent trainings if there is anything else with which they feel they need help or if there is a specific task we could help the patient learn that would aid in increasing the number of opportunities the patient has to learn that task in the home setting. Any task that is performed independently by the patient is time freed for the parent. We increase the quality of life not just for the patient, but for the family unit. When we are flexible in programming and honor parent requests when possible, we pair ourselves with positive interactions, building rapport, thereby increasing the likelihood that parents will comply with treatment recommendations. We do all of this using the principles of ABA with the family, and we are also becoming part of a unit that works for the patient. All. For. One.
If questioned about my professional ethics for using ABA principles with a patient's family, I would respond that my professional ethics guide me to do what benefits the patient first, which is why I am so heavily invested in positive outcomes for the family unit. In order to secure these positive outcomes gaining trust from the family is essential. If applying ABA principles to my patient's parents will assist in obtaining these positive outcomes, I will always opt to take advantage of these principles in my interactions with parents.
Quote: "No man is an island." John Donne
Quote: "You must be flexible." Domonique Randall, BCBA-D – CEO The Shape of Behavior