You say “toMAYto” and I say “toMAHto”

www.johnbragg.com

May is Better Hearing and Speech Month.  Speech and Language Pathologists like to use this month to educate and teach others more about what we do and how to better ourselves as clinicians.  As an SLP, we work with many therapists OT, PT and BCBAs. Many of us use the same vocabulary and many terms can differ. As an SLP working in a team with BCBAs it is vital to know what we are all talking about! I could say “toMAYto” and a BCBA could say, “toMAHto,” but we really just want to get along and understand each other! We came together and created a vocabulary list to better understand each other.
Here are some of the common terms we both use and how we really are meaning the same thing!
Some of the common speech terms that overlap with BCBA terminology is listed. The Speech term is first then the ABA term:  Requesting-Manding, Labeling-Tacting, Imitation- Echoic, and Fill in- intra-verbal. Knowing these basic terms will help the SLP and BCBA and ABA therapist to understand each other. We may speak different languages but we are all trying to come together and work as a team to get the same result.
— Hannah Trahan, MS CCC-SLP & Nicole LeMaster, MA BCBA

SLP Term Translation
Label Tact
Request Mand
Imitation Echoic
Fill in Intraverbal Fill in
Open ended question Intraverbals
Non-verbal Non-vocal
Code switch a different means of interacting with people based on your learning history with them. Ex: the way you talk with friends vs. the way you talk with co-workers
Motor planning being able to complete the steps necessary to do an activity. Being able to move your body to get the job done.
Articulation Speech sounds
Executive functioning Problem solving
Therapy of mind Perspective taking
Central coherence ability to focus on details as well as the whole picture
AAC Alternative Augmentative Communication
Fluency smooth, rhythmic, effortless speech
Dysfluency stuttering
Syntax grammar
Semantics word meaning

Why Changing a Child’s Team is a GOOD thing

therapistCHANGE.jpg

Throughout the course of a child’s treatment with any ABA provider, one thing should be a constant: therapist changes happen. Frequently.

And understandably, this tends to be a difficult adjustment for both our kiddos and their families! In order to continuing developing the best team possible, there are occasionally team changes as a result of professional growth and career advancement, however, it’s important to recognize that team changes do not solely occur because staffing dictates; as an ABA provider, our ultimate goal is to ensure that your child receives the absolute best quality treatment, and one element of providing a well-rounded ABA program is therapist change.

Why?

There are a multitude of benefits to changing therapists, however, we’re going to focus on two: generalization of skills and functional relationship building.

Requiring a learner to be able to respond to new therapists is an important, often under-utilized form of teaching generalization. While learning a new skill with a specific therapist is an amazing accomplishment for a child, it is equally important to ensure that skills taught aren’t just generalized across different environments, but across different people as well.  For instance, a child may return a greeting daily to the therapists that have been teaching them this skill for 6 months, but that doesn’t necessarily mean that, if a novel persons says ‘Hi,’ the response they’ve learned with their typical therapist will generalize.

In addition to generalization, building relationships with and responding to novel people regularly will help set up your child for success in the future. In school, work, or other standard day-to-day activities, we are expected to be able to form and cultivate relationships with new people. Whether it’s a new teacher, a new boss, a new neighbor, a new babysitter or family member, being able to and confident in responding to new faces is always beneficial to a child.

In the end, we understand that therapist changes can be a difficult adjustment for everyone involved, but the benefits of regular team changes will only help children to meet their goals.

Topics in ABA: Experience Trumps Credentials

4d2660c72722dbea504db6b0882dd079.jpg

Over the past 10 years the number of BCBA’s has grown from approximately 2,500 in 2005, to close to 20,000 in 2015.  This growth is partially due to the increase in availability of certification programs in the field of behavior analysis. Although there is a growing need for behavior analysts, many students have been entering degree programs with little or no experience working in the field of ABA and a limited knowledge of what a behavior analyst actually does.

As professionals who have supervised and taught in certification programs our experience has been that the most successful students are those that have a background in ABA and have had the opportunity to demonstrate those principles in the natural environment (for our sake, with kids with autism). We have unfortunately witnessed unsuccessful students and a common denominator is typically jumping into a certification program without truly understanding the roles and responsibilities of a BCBA.

As a behavior analyst you have the ability to change behavior! We can make a huge difference in the life of a child with autism and their family; this is something that should not be taken lightly. This is why we are dedicated to not hire or promote individuals because of their credentials, but instead due to their experience and proven ability to be effective at what they do.

Chrissy Barosky M.Ed BCBA, & Danielle Pelz, MS BCBA

Precision teaching & fluency based instruction training

One topic that I want to expand upon from the clinical priorities list is precision teaching & fluency based instruction training…

We know that in order to make the most meaningful gains with our learners,we need a strong system of measurement in place. Measurement allows us to make decisions about what we are teaching and how we are teaching it. The better the measurement, the better the decisions. The better the decisions, the better the learning. As a team, our primary goal is to maximize the efficiency and effectiveness of our instruction so our children can grow as quickly as possible. Precision Teaching is a method of standardized measurement and visual analysis using “the chart”, and is based on core behavior analytic principles. All locations have received training and are introducing the “chart” into their programs. Over time, we will develop more intense trainings to teach our clinical team how to develop programs and make quick decisions based on data patterns.

Laura Grant

Vice President of Clinical Development7722524_orig.png

Topics in ABA: The Missing ‘A’ in ABA

person-girl-cute-young.jpg

What truly sets us apart from most other providers is much simpler than one would expect- that is, a developed team of Behavior Analysts whose sole, full-time responsibility is to ensure clinical programs are designed to the highest quality.

The increased rate of autism diagnosis has led to a concurrent increase in providers claiming to provide efficacious treatment.  One way of keeping up with demand has been by creating a model of provision in which application can be easily replicated, from one client to the next.

The model looks something like this: 1) Assessment (typically a behavior analytic assessment such as the VB-MAPP); 2) Language and behavior programming 3) Application of the program through therapy and 4) Data collection.  What results is a set of rules, and providers develop only the skills necessary to follow those rules. Unfortunately, throughout this process, and particularly after data collection, not much “analysis” is done at all.  What is lost when services take on these characteristics is the 2nd “A” in ABA, …the most important part of what makes ABA effective in first place.

Within the community of behavior analysts, we identify these services as “Applied Behavior”.  And most providers do not even realize they are doing it.

In our October newsletter, we discussed the movement within our organization towards a more systematic and thorough system of measurement.  Measurement is the key to effective behavior analysis, as it allows our BCBA’s to identify patterns of behavior change, or trends, and to make decisions about our kids learning.  Through these data sets, and the patterns identified, Consultants and BCBA’s learn from their clients, and the analysis and effectiveness of programming grows exponentially.

We are taking this focus on Analysis a step further.  Our entire team will receive will receive extensive training in the upcoming year on how to analyze data and behavior as it occurs throughout a session.  This includes everyone from the Consultants to the Therapists. We will be trained to analyze client’s learning, minute by minute, and make decisions about what to do differently to ensure that learning does not have to “sit and wait” for our consultants to see change is needed.  All therapists will receive intense training on their own decision-making, and data will show that our therapist’s decisions are in line with our highest skilled BCBA’s.  We look forward to striving to be the BEST!

Laura and Liz 

A quick word on Precision Teaching AKA ‘The Chart’

IMG_5368.JPG
Precision teaching & fluency based instruction training…

One topic that I want to expand upon from the clinical priorities list is precision teaching & fluency based instruction training…

We know that in order to make the most meaningful gains with our learners,we need a strong system of measurement in place. Measurement allows us to make decisions about what we are teaching and how we are teaching it. The better the measurement, the better the decisions. The better the decisions, the better the learning. As a team, our primary goal is to maximize the efficiency and effectiveness of our instruction so our children can grow as quickly as possible. Precision Teaching is a method of standardized measurement and visual analysis using “the chart”, and is based on core behavior analytic principles. All locations have received training and are introducing the “chart” into their programs. Over time, we will develop more intense trainings to teach our clinical team how to develop programs and make quick decisions based on data patterns.

Laura Grant

Vice President of Clinical Development

Topics in ABA: Assent Withdrawl

children.jpg

Consent- n. permission or agreement to do something.

In clinical practice, we know and value consent as an ethical requirement for treatment. We always make sure that the parents of our clients understand the treatment, the risks and benefits, and agree to services. What about the kids, the direct clients we serve though? It is their right to agree to treatment as well, and often times our clients are too young, or don’t have the skills to provide us with their consent. In these situations, they do have the ability to provide us with their assent.

Assent- n. the expression of approval or agreement.

We would all agree that happy learners are much easier to teach, and make more progress when happy.  A child who shows up to the table, or complies easily with directions makes more progress than those who struggle in these areas. Gaining assent of our clients demonstrates a respect for their opinion, as well as ensures our kids are at their best during each teaching moment.  When a child withdraws assent, it can be something as simple as not attending to instructions, “spacing out”, or it can be more clear- tossing the materials off the table. Either way, the child is communicating to us that something is not right. It is important that they are heard, and their withdrawal should function to us as clinicians to make changes to the intervention, and most importantly to capture the teaching opportunity to improve our client’s self advocacy skills.

Moving forward, we will be improving our training and understanding of Assent Withdrawal, always looking out for what is best for our kids!

Liz Lefebre, MA BCBA 

Vice President of Programming and Strategy

Clinical Corner: Our Priorities

We’ve talked about our theme of being the best provider of services for children with autism. This year we’ve been working across our locations on multiple projects to continue to enhance our skills.

Some of the key highlights include training our teams to use the world around them to teach in an even more playful and naturalistic way, focusing on social reinforcement as our primary goal to teach new behavior, and taking a closer look at our system of measurement to ensure efficient progress.

As we look ahead to the next few months, we have several exciting and challenging projects that we’re actively working on. Here’s a quick sneak peek at our clinical priorities list:

  • Enhancing our consultant training
  • Continued development of key clinical processes:
    • BIP’s (Behavior Intervention Plans)
    • Program Binder Organization
    • Data Rules
    • Error Analysis
    • Case reviews
    • Mand flow data sheets
    • Implementation of Precision teaching & Fluency based instruction training
    • Development of Electronic Training Platforms (Lessonly)

A clinical team comprising Liz Lefebre MA BCBA, Laura Grant MA BCBA, Danielle Pelz M.Ed BCBA, Chrissy Barosky MA BCBA, and myself is leading the development and implementation of these projects.

Finally, we’ve made great strides this year as a team. I am incredibly proud of our team and the great effort that gets put in every day. Let’s continue to raise the bar and expand the scope of what’s possible with our kids.

 

– Courtney, President Clinical Development

May is Better Hearing and Speech Month

May is Better Hearing and Speech Month, a time to raise awareness about communication disorders and the Speech-Language Pathologists and Audiologists who provide treatment.

BHSM_logo

A Speech-Language Pathologist (a.k.a. Speech Therapist) is a professional who evaluates and treats children and adults with speech and language delays or disorders. On the hearing side of things, an Audiologist is a person who provides diagnosis and rehabilitation of hearing loss.

I have worked as a pediatric Speech-Language Pathologist (SLP) for nearly 12 years now. I learned a lot in school to help me with my profession, but my real education has come from everyday experiences in working with children and their families. These invaluable experiences have molded me into the therapist I am today. One important topic comes up frequently when talking to parents: most wish they had more knowledge and awareness of speech/language development so they knew sooner that their child’s development was delayed.

The two main areas of communication development are Language and Speech. Language is the rule-based system that we use to communicate, including what words mean, how they can be put together, and how to make new words. It is made up of Expressive Language (what is said) and Receptive Language (what is understood). Speech is the actual verbal communication and includes fluency, voice, and articulation. SLPs also work on Pragmatics, the social use of language, and aural rehabilitation, after children receive hearing aids or cochlear implants. The American Speech-Language Hearing Association (ASHA) has fantastic resources on speech/language development that can be accessed here: http://www.asha.org/public/speech/development/chart/.

There is little information on the incidence of communication disorders and delays in the United States. In the 2005-2006 school year, 1.1 million students were classified in schools as having a “speech and language impairment”. This number is certainly higher to account for children who receive therapy in outpatient clinics, non-public schools, and in the home. Beyond these numbers are the numbers of children diagnosed with Autism. It is now estimated that 1 in 68 children are on the Autism Spectrum. 1 in 68. What this means for SLPs is that our caseloads are being made up more and more of children who have a diagnosis of Autism. Not all children with autism have speech/language challenges, many need help learning to follow directions, take turns talking, greeting others, saying words, signing, and imitating gestures and actions. The list goes on and on. A lack of or delay in communication is often the first sign parents have that something is going on with their child’s development and so it is so important to understand typical development.

All of that is the technical information about what I do. It is very important that parents, families, and the public understand what speech and language is and when to recognize a delay or disorder. But, I can tell you that there is so much more to what we do. This is a job that my fellow SLPS and myself are extremely passionate about. We LOVE helping children learn to communicate! There is nothing more rewarding than the first time a child says a sound, word, or their first sentence. THAT is why we do what we do every day.

Kristin Kouka, MA, CCC-SLP

Speech-Language Pathologist

Kouka Kids Speech Therapy, LLC

Little victories are so much sweeter.

bigstock-Kids-With-Tablet-41839423

This is a guest post written by a former employee (whom we miss very much!) Amy Sartin is a BCBA living and working in California and offers these valuable insights for Autism Awareness Month.

“April is Autism Awareness Month! After close to a decade working with children with autism and other developmental disorders, here are my thoughts:

Autism can happen to anyone, anytime. Autism is not a reflection of poor parenting, or lack of education. Autism knows no race, ethnicity, culture, religious, or monetary bounds. I have seen the very strongest parents face the most unimaginable challenges with their children. One thing is for sure – raising a child with autism is not for the weak.

Often the media reports the negative side of autism – and let’s be clear – children and families with autism have to overcome so many obstacles, every single day. For a child with autism, something as simple as putting on clothes or eating breakfast can be difficult.

But here’s the thing – autism is not all darkness and doom. After working with hundreds of children on the spectrum, I have learned to appreciate the small things. Little victories are so much sweeter. Seeing something as simple as watching happy kids playing at recess or giving their dad a hug can bring tears to my eyes. Watching a child with autism communicate for the first time – whether it is vocally or through other means – will NEVER get old. Nothing makes me smile quite like a visit from a former client. Every single child I have ever gotten the opportunity to work with will always have a special place in my heart. There is nothing better than seeing a child master a skill that they have been working on for several days, weeks, or even months. I will never cease to be amazed by the kids I get to see every day.

Working in this field is not easy – but whether you are a teacher, a therapist, a consultant, or even just a nanny for someone with special needs – we HAVE to keep this perspective. We cannot become jaded. Take a moment to appreciate the amazing things we get to see every single day. Thank a parent who has entrusted you with their most precious gift – their child.

To those who are not affected by autism – take a moment to appreciate the little things. Smile at a child you see in the grocery store. Give your child an extra hug. Most of all, always keep things in perspective.”