It was my first day of a new job. I walked into a super-confrontational meeting between parents and a school district. The discussion was heated. The district was very unsatisfied with the current behavioral consultation and the parents were extremely happy with the current consultants. During the discussion a school district leader asked me, “How long will it take for you to learn about this student and take over the consultation?”
That was a very tough question. There were about 15-20 people in the room. I had met a few of them earlier in the day. I didn’t know much about the student besides what I heard during this difficult meeting. I don’t even know what the rest of my caseload will be like and how much time I can devote to the case. If I say it will take quite some time, I’m sure to upset school district leaders who are furious with the behavioral consultants. If I say I can do it quickly, I’m sure to upset the parents who I haven’t even met outside of this heated discussion. Everyone is emotional and on edge. What to do?
“Well, this is my first day and I think I can remember where the bathroom is located.”
After that, I was able to talk a bit about how I would get to learn about the student without making any specific commitments about when I would complete the project. I was able to build rapport with the parents and school district leaders in subsequent weeks. Many other times, I haven’t been so lucky.
The problem is that as BCBAs we are supposed to make recommendations based on the scientific literature. Often, however, we are asked to make recommendations where it isn’t easy to point to the literature that would justify specific recommendations.
- How many hours of consultation per week are required for the student to have an “appropriate” program?
- Does this student need a 1-1 Registered Behavior Technician in order to have an “appropriate” program?
- Is this goal “medically necessary”?
We can certainly interpret the scientific literature to make recommendations like this even if there is no study exactly on point. We can collect data to inform these decisions. We can and should do both of those things.
I would suggest that in addition, it is important to realize that in the real-world, decisions like these are often made on the basis of arm wrestling. It is more like buying a used car than a debate on the science. Sure, data and scientific literature can help, but it usually only has a small impact on how decisions are usually made. That’s because many times there is no obvious science-based answer to these types of questions and different BCBAs are likely to disagree. Knowing the science and how to collect data to evaluate decisions is necessary, but not sufficient to handle these situations well. Learning to negotiate the complex social environment is essential too.