Tip #108 A Call for Human-Centered Training: Revisiting BCBA Interventions in Residential Care

 Supporting the Adult Population as a Board-Certified Behavior Analyst (BCBA)

Tip #107 Organizational Behavior Management (OBM) Onboarding Systems: Why Are They Important...?

Supporting the Adult Population as a Board-Certified Behavior Analyst (BCBA)

Tip #106 A Behavior Analytic Look at Crip Camp and Systemic Ableism

Supporting the Adult Population as a Board-Certified Behavior Analyst (BCBA)

Tip #105 Bridging Gaps, Navigating Power: Advocacy When Caregivers Overshadow Input

  

Supporting the Adult Population as a Board-Certified Behavior Analyst (BCBA)

# 104-Tips for Supporting the Adult Population as a Board-Certified Behavior Analyst (BCBA)

Tip #104: How to Build Rapport with Support Staff (The Formal Caregiver)

Pastor Priscilla Shirer, an American author and motivational speaker, once said during an event that when faced with adversity, never focus on the problem. Instead, focus on the strategy. She emphasized asking God, “What is my strategy for this problem?”—trusting that clarity will come. Early in my career, when I faced ongoing resistance from support staff, I found myself asking a similar question. The answer was clear:

Build rapport.

Trust is the foundation of progress. Once people trust you, they’re more likely to be open to learning from you. Interestingly, this mirrors a fundamental principle in ABA: building rapport with the individuals you serve as a proactive strategy. Yet, as professionals, we may not always realize that rapport-building is just as essential when working with the team supporting those individuals.

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Formal vs. Informal Caregivers

When supporting the adult population, it’s important to distinguish between two types of caregivers:

1. Informal Caregivers: These are family members or loved ones who provide daily care, often within the same household. Their responsibilities may include transportation, assistance with hygiene, meal preparation, and other daily needs. Some informal caregivers may even receive compensation through state-eligible programs.

2. Formal Caregivers: These are paid professionals, often referred to as support staff. They work for agencies or organizations and provide direct care in various settings, such as the service participant’s home, residential care facilities, day rehabilitation programs, or vocational support settings.

While it’s vital to build strong relationships with both families and individuals receiving services, prioritizing rapport with formal caregivers is equally, if not more, critical. Support staff are the ones implementing the BSP strategies day in and day out. They are your key resource for ensuring treatment fidelity.

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Why Rapport Matters

Building rapport is essential for fostering collaboration and ensuring the success of interventions. Research shows that people are 4 times more likely to agree to requests from individuals they feel connected to (Cialdini, 2001). When rapport is strong, support staff are more likely to:

• Be receptive to feedback.

• Demonstrate treatment integrity.

• Actively participate in interventions.

Conversely, a lack of rapport can result in resistance, aversion to feedback, and even escape or avoidance behaviors from staff—all of which negatively impact client outcomes.

The Ethics Code for Behavior Analysts (BACB, 2024) underscores the importance of collaboration in Code 2.10: Collaborating with Colleagues:

“Behavior analysts collaborate with colleagues from their own and other professions in the best interest of clients and stakeholders. Behavior analysts address conflicts by compromising when possible and always prioritizing the best interest of the client. Behavior analysts document all actions taken in these circumstances and their eventual outcomes.”

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Three Recommendations to Build Rapport with Support Staff

1. Start with Leadership

Begin by building a relationship with the supervisor overseeing the support staff. Supervisors play a critical role in shaping their team’s approach and attitude. They can provide insights into staff dynamics, suggest optimal times for direct observations, and offer feedback on team needs.

• Meet with the supervisor to ask about their priorities and the team’s needs.

• Document all communications, especially if resistance persists.

• If needed, seek guidance from your own supervisor to address ongoing challenges.

Starting with leadership not only builds trust but also demonstrates respect for the chain of command.

2. Be Present

Regular direct observations are essential. Use your visits to check in with both the individual being supported and the staff. Conduct interviews to identify barriers that may prevent staff from being effective. During this process:

• Focus on active listening to show staff that their voices are heard.

• Avoid corrective feedback unless there is evidence of abuse, neglect, or noncompliance with regulations. In such cases, use a “call-in” approach: ask questions to understand the situation before addressing the issue collaboratively, rather than using a punitive “call-out” approach.

• Resist the urge to make immediate changes. Spend at least 2-3 months learning the organization’s culture and dynamics before proposing adjustments. Making changes too quickly can make you seem adversarial.

3. Identify Staff Priorities

Build trust by being curious about staff needs and priorities. Ask questions such as:

• “What challenges are you facing when implementing the plan?”

• “What areas do you think we should focus on together?”

Use their input to inform your recommendations. When staff see their concerns reflected in your actions, they are more likely to collaborate and implement strategies consistently. Additionally, model your responses during direct observations to demonstrate that your suggestions work in practice.

Recommended resources to assist with the rapport building process: 

• Parry-Cruwys, “Episode 254 - Improving Your Parent Training Practices.” ABA Inside Track. Podcast Audio, October 11, 2023: This podcast discusses strategies for improving parent training, which can also be adapted to enhance rapport-building with adult support staff in behavior analysis settings.
• Anderson, B. M., Hall, C., & Maic, K. (2023). People Skills for Behavior Analysts. Routledge: This resource highlights essential interpersonal skills for behavior analysts, emphasizing the importance of empathy, active listening, and trust-building in fostering effective relationships with clients and colleagues.
• Leach, M. J. (2005). Rapport: A Key to Treatment Success. Complementary Therapies in Clinical Practice, 11(4), 262–265: Leach’s article explores how establishing strong rapport with clients significantly enhances treatment outcomes by fostering trust, cooperation, and effective communication.

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Final Thoughts

Building rapport with support staff is not just a soft skill; it is a professional necessity. By investing time in relationship-building, you lay the groundwork for successful collaboration, improved treatment integrity, and ultimately, better outcomes for the individuals you serve. Remember, as Cialdini’s research and the BACB Ethics Code both highlight, trust and collaboration are the keys to progress.

Take a step back, connect, and let rapport be your strategy.

If you read this, the seed has been planted... the question is how are you going to apply it...

From the one and only... Shanda J Your BCBA

Resource: 

Behavior Analyst Certification Board. (2024). Ethics Code For Behavior Analyst. [PDF]. Retrieved on https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240830-a.pdf

Cialdini, R. B. (2001). Influence: The psychology of persuasion (Rev. ed.). Harper Business.

#103 Tips for Supporting the Adult Population as a Board Certified Behavior Analyst (BCBA)

Tip #103- Paradigmatic Shift in Adult Applied Behavior Analysis (ABA) Practices 

As a BCBA supporting the adult population, you are trained to utilize a pathogenic approach. What is a pathological approach from an ABA lens? Well, from a pathological perspective, a clinician provides treatment based on the individual's clinical diagnosis. If you've worked in the field long enough, you know that typically the additional recommendations along with ABA practices involve a psychiatric provider overseeing psychotropic medication and other therapeutic practices.

Let's consider a paradigm shift in our daily practices and utilize a more parsimonious approach. We can accomplish this by considering the ecological factors that are resulting in the behavioral challenges. By getting to the root of the problem, we can develop more effective interventions. Yes, medication and other therapeutic approaches can be helpful recommendations. However, from a behavior-analytic perspective, if the deeper function of the behavior is not addressed, the individual will likely engage in response generalization whenever certain stimuli are present, whether covertly or overtly.

Thomas et al. (2018) published a systematic review emphasizing "whole person care" and how it should be applied to patients. The article illustrates how the following components should be considered to integrate and attend to the whole person: their context, including biological, psychological, social, and possibly spiritual and ecological factors.

The Ethics Code for Behavior Analysts (Behavior Analyst Certification Board, 2024) supports this approach in Code 2.19: Addressing Conditions Interfering with Service Delivery. This code states that behavior analysts should actively identify and address environmental conditions (e.g., the behavior of others, hazards to the client or staff, disruptions) that may interfere with or prevent service delivery. In such situations, behavior analysts should remove or minimize the conditions, identify effective modifications to the intervention, and/or consider obtaining or recommending assistance from other professionals. Behavior analysts should also document the conditions, all actions taken, and the eventual outcomes.

As we transition into 2025, let's consider applying the following strategies to create a culture of paradigmatic shift in ABA practices supporting adults:

Motivational Interviewing: As a clinician, when you have the skill of motivational interviewing, you can ask the right questions to identify the ecological factors and the learning history of the individual. This will also help with identifying setting events (i.e., CMOs), rule-governed behaviors, confounding and extraneous variables, that lead to the function of behavior. Below are some resources to assist you with motivational interviewing:

• Books or peer-reviewed literature: Enhance your skill set during the indirect assessment process when you conduct interviews.
• Resource: Gilbert, M. (2020). How to Stop Talking and Start Communicating: Motivational Interviewing: A Behavior Therapist's Guide on How to Effectively Collaborate with Caregivers. Crystal Minds Psychological Services.
• YouTube videos: Find videos on the topic by searching the keywords "Motivational Interviewing ABA."
• Resource: Behavioral Observation Podcast. (2023, August 22). What is Motivational Interviewing? Session 236 with Callie Plattner [Video]. YouTube. https://www.youtube.com/watch?v=ET48ySU04hM&t=1s

Record Review: I know we are rushed due to high job demands and caseload needs. However, taking the time to review previous and current reports helps you gain further insight into the individual's background and assess what additional resources may be needed to support the person.

Data Monitoring: Data is essential! Always collect data and closely monitor the case. This way, if additional supports are added, you can conduct a component analysis to identify the effectiveness of different treatments and services and how they may be impacting the individual's behavioral progress.

If you read this, the seed has been planted... the question is how are you going to apply it...

From the one and only... Shanda J Your BCBA

Resource: 

Behavior Analyst Certification Board. (2024). Ethics Code For Behavior Analyst. [PDF]. Retrieved on https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240830-a.pdf

Thomas, H., Mitchell, G., Rich, J., & Best, M. (2018). Definition of whole person care in general practice in the English language literature: a systematic review. BMJ OPEN, 8, 1-12.  https://bmjopen.bmj.com/content/bmjopen/8/12/e023758.full.pdf

Tips for Supporting the Adult Population as a Board Certified Behavior Analyst (BCBA)- #102

  Tip #102- Application of Artificial Intelligence (AI) in Applied Behavior Analysis (ABA)

According to the Department of Health and Human Services, data reflected in 2023 the utilization of AI tripled from the previous year (Adler, 2023).  Statics also reflects currently the AI market is around $279 billion, an increase of $80 billion since 2023 with a compound annual growth rate of 37.3% from 2024-2030 (Grand View Research, Inc., n.d). 

In 2024, if you're a BCBA that is not utilizing AI within 80% of your daily practices. My friend be mentally prepared to utilize AI more consistently in the future. Most agencies look at AI as a tool to increase productivity and effectiveness.  Yet, there are still many concerns surrounding AI such as the risk of data dissimulation, ethical barriers, and hackers. 

Whether you are providing direct impact (I.e., working directly with the RBTs, Direct support staff, and families) or more on an organizational level (I.e., State Director, Supervisor overseeing mutiple BCBAs). 

Below are some things to consider as we gradually fade into utilizing AI in our daily practices.

-Ethics: Staying up to date with the BACB's ethics code on best practices utilizing ABA and AI. Currently, there are no specific ethical points identified in our ethics code. But the current ethics can be disseminated to AI practices (Ethics Code for Behavior Analysts).

 

-Research: Attend seminars within all job sectors to identify how AI tools can be utilized within your daily practice. It is recommended you gain clarity from leadership first before implementing any AI resources. Most organizations have bylaws and rules around the use of AI and how it can be applied 

• Resources such as Grammarly, ChatGPT, Zoom features "AI Companion"
• Sign up to free Alpaca Assistant: www.alpacahealth.io 

-Consent: Notify clients how you're utilizing AI as an assessment tool. It is highly recommended to make them aware during the initial intake process. Ensure the client is aware of how the tools will be used and the protection surrounding the company's data.

-Back-Up Plan: Identify different ways to still do your job effectively. This way if something happens to your AI systems you can continue services and minimize the lapse of service. Go old school by using paper and pen or identify systems within your daily practice such as, saving information to a USB drive or printing out hard copies.  

Below are some resources addressing the use of AI within the workplace:

• Navigating the Ethical Terrain of Generative AI in Behavior Analysis: A Three-Part Series
• The Promises and Possibilities of Artificial Intelligence in the Delivery of Behavior Analytic Services
• The impact of artificial intelligence on human society and bioethics
• Starting the Conversation Around the Ethical Use of Artificial Intelligence in Applied Behavior Analysis

References:

Adler, M, (2023, August 15). HHS’s artificial intelligence use cases more than triple from previous year. FEDSCOOP. https://fedscoop.com/hhs-ai-use-cases-more-than-triple/

Grand View Research, Inc.  (n.d.) Global Artificial Intelligence Market Size & Outlook. Retrieved on 11/20/24 from https://www.grandviewresearch.com/horizon/outlook/artificial-intelligence-market-size/global