Author: Barry Morgenstern

There is tremendous value in actually seeing what other people are doing. Sure, it is great to read the latest research and go to conference presentations. But there is no substitute for actually seeing what’s happening. You learn things from seeing a program or a procedure that you simply can’t pick up from reading or listening to presentations.

At the beginning of my professional life, I did whatever I could to go visit programs that were supposed to be of very high quality. That’s a lot of work to set up and arrange the visits. I cold-called the directors of the programs, and they were very accommodating. Some of them even spent hours with me showing me around and teaching me about their programs.

During my first year in a real / non-internship type job, I took at least four vacation days to visit programs that were supposed to be of the highest quality in my area. In later years, I continued this practice and had the opportunity to visit many, many different types of programs over the years, which was a fantastic learning experience. On a few occasions, I even took trips by plane to go visit programs. I met a lot of people this way and it was an excellent way to learn things that probably wouldn’t have been possible in any other way.

There was a lot less interest in behavior analysis back when I was starting my career. I expect if someone today attempted to replicate my procedures, program directors in 2021 are not likely to be so accommodating. This is even more true after COVID-19.

On the other hand, maybe it isn’t nearly as necessary as it was 25 years ago. Today we have something that we didn’t have 25 years ago–online video platforms. On various platforms, you can view videos of people working with children with autism. Like Eddie Murphy warned, you are likely to see some stuff that sucks, but you will see some great stuff too. Regardless of how you do it, find a way to go see what other people are doing. If you don’t, you won’t Poogi nearly as much as you could.

In the 1960s through the 1980s there was a series of commercials where Mr. Whipple would try to stop people in the grocery store from squeezing the Charmin™ bathroom tissue. Now, it was never terribly clear why people in the store weren’t allowed to squeeze the Charmin, but lots of people sure loved to squeeze it, and it was against the rules. Even Mr. Whipple liked to squeeze the Charmin himself. Rules are rules. But this rule was annoying to lots of people.

This happens all the time when we work with children with significant behavior problems. One of the most important things we can do is create a fun environment for them to learn new skills. Too often, adults mess this up with rules that are about as important as “Please don’t squeeze the Charmin.”

• Don’t mix the play-doh colors
• Please keep all the toys in the play area
• Color in the lines
• Don’t sit so close to the TV
• No rice outside the box
• Don’t hold the tablet so close to your face
• That toy is too loud.

I understand this can be difficult. Letting kids play the way they want to play can make a huge mess. It can be annoying for the adults (Who would want to do an awful thing like mix play-doh colors?) I once worked in a rented space that had an office next door. The people in the office complained because this toy was playing so frequently throughout the day. The wrong thing to do would be to tell the child he can’t play with the toy. We moved the child to another space and had a child who was quieter in the room that overlapped with the office.

But focusing on the little stuff is a serious error at the start of treatment. It ruins rapport; it makes the environment much less fun, and it sets up a situation where kids don’t want to be cooperative. I find that we often underestimate the importance of this step. In many cases, it is the difference between success and failure. I’d say making up rules like “Don’t squeeze the Charmin” is one of the most common reasons for failure in public schools.

Of course, this doesn’t mean a free-for-all. You can take this advice too far. Setting reasonable limits is fine. Just don’t be a killer of fun like Mr. Whipple.

In this blog, I’ve frequently warned you about all the things that can go wrong when managers start measuring staff performance and explained what you shouldn’t do. That’s not great teaching. In behavior analysis, we know it is not sufficient to tell people what not to do. We need to tell people what to do instead. So, today, I’d like to focus on one positive suggestion of something I think that managers should measure. Although I think this measurement could apply to many jobs, it is especially relevant for RBTs (Registered Behavior Technicians) or other staff working with children with autism or other developmental disabilities.

Suggested Measurement: The frequency of suggestions for improvement in processes, or any series of steps needed to accomplish a result.

Why this is a strong measurement:

1. Staff needs to clearly understand the current processes to make suggestions for improvement.
2. Staff is more likely to follow the current processes if their attention is focused on the processes.
3. Your staff is most likely to be able to recognize weak processes and suggest improvements.
4. It highlights poorly managed systems where there aren’t sufficient processes in place.
5. It is often reinforcing to staff to have their suggestions implemented.
6. This is the main thing that programs need to be on a Poogi.

Of course, you must be careful and have a process in place so that you don’t implement bad suggestions that staff might make. That is a bit tricky, especially if they don’t think you know what you are doing. Staff still need to feel safe so they are not afraid to tell the truth. I’ve previously made suggestions on how to do that.

Just about everyone who enters fields like education, psychology, counseling, or behavior analysis has good intentions. We want to do the right thing and make a significant difference in the lives of the people we serve. But in one well-known study on mentoring for at-risk youth, the results of the long-term follow-up were just awful. On every measure, including how long they lived, job and marriage satisfaction, mental health, physical health, alcoholism, the at-risk youth who had mentors performed worse. In other words, if you were an at-risk youth, you would be much better off if these people trying to help you just left you alone. In fact, there appeared to be a dose relationship; the more mentoring you received, the worse you did in life.

One particularly interesting finding is that many, many of the men who were in the mentoring group remember their mentors fondly, giving them credit for keeping them out of prison and improving the quality of their life. Yet, most of them were probably wrong. Likely, they would have done better without any mentoring at all.

Now, this is not an argument to avoid trying to help people in trouble. But realize that just because you have good intentions and you attempt to help doesn’t mean that you will succeed. Most professionals refuse to believe that their intervention might be harmful in the long run.

BCBA’s (like all other professions) don’t think that this argument applies to us. And behavior analysis has a better argument than many fields. First, in behavior analysis, we have long-term studies that show great improvements for many children with autism. Second, we have a culture of constant data-based decisions. If our interventions are not effective, we make changes based on the individualized needs of the child.

The problem is that most of those long-term studies were not done under the practical conditions you and I face every day. Most weren’t done in public schools with countless rules and requirements that are far from optimal. They weren’t spending precious therapy time on all kinds of notes, filling out forms with procedure codes, and other stuff that health insurance companies require. In the old days, we met as a team–usually weekly. Insurance companies don’t pay for that, so it typically doesn’t happen any longer. Does that make a difference in the long-term outcomes?

Even if all those differences don’t change outcomes much, some children don’t have very positive long-term outcomes. I think this is particularly true in the treatment of severe problem behaviors. Things can look good for a long time before they fall apart.

We need long-term research data. Unfortunately, that’s difficult and extremely expensive.  In the meantime, we can think long-term and avoid being overconfident.

A long time ago, in a galaxy far, far away, I had a very intense job. Actually, I’ve had more than one very intense job.

At one job, I was a waiter, and Monday mornings were generally a bit slow. In fact, so slow that often, the manager and I were the only ones working. The manager had to leave to make bank deposits on Mondays, leaving me alone to run the restaurant. Most of the time this wasn’t a problem. A customer would come in and I’d pour the coffee, throw the eggs down on the grill, butter the toast, take cash at the cashier, and on to the next customer. Even with just 4 or 5 customers, it was a bit hectic, but I could handle it. I made $2 per hour, plus tips. Occasionally, the manager would leave, and I’d get a flood of people—I could hardly breathe until the manager returned. Since the restaurant was in a vacation area, sometimes the same family came in for breakfast, lunch, and dinner, and I served them all three times because I’d sometimes work 12-hour shifts from 9 AM-9 PM. I didn’t have time to sit down once and they’ve all eaten their third meal.

The thing is, I liked when it was super-busy. Not just because we were paid mostly in tips, but also when things were that intense, I would get into a flow, and time just flew by. I would get to work, and in the blink of an eye, my 12-hour shift was over. Working intensely without interruptions feels good.

Later, I worked as a supervisor in a program for children with autism which was intense in different ways. I was again super-busy—I had a huge caseload. And while I didn’t yet have a cell phone, I did have email. I often received a lot of emails that were important, urgent, and needed to be answered quickly. This was before the BACB (Behavior Analysis Certification Board), and we didn’t have things like limits on caseloads. The amount of work (and email) I had was staggering.

Yet, the work at the program for children with autism didn’t feel like the work at the restaurant. It didn’t fly by quickly. It felt intense and stressful most of the time. Sometimes I’d get that feeling of flow like at the restaurant, but not usually. As I’m learning from Cal Newport’s new book, that might have been partially caused by the email. Email can cause stress, anxiety, and generally be an ineffective way to get work done. Answering emails is much different than serving customers at the restaurant or working intensely with a client. You don’t get that positive feeling of flow from email.

There are many lessons to learn here. Be suspicious of how email / text messages are influencing your work. I have argued before that sometimes we make a huge mistake when we think that an email or a text is a substitute for a conversation. I’ve also argued that having your phone on while working with clients will substantially decrease the quality of your work.

I’ve been working on workflow systems for many years, and it is still a work in progress. You are unlikely to learn how to organize yourself, handle enormous loads of email, text messages, and prioritize your workload in a graduate school class or a CEU course. But these are skills all professionals need to learn. There are lots of potential ways to improve, but just realizing that these things can have a big impact on your effectiveness is a good first start.