Author: Barry Morgenstern

BCBA’s are extremely busy. There are enormous demands on our time. There are clients to see, staff to supervise, presentations to give, meetings to attend, administrative work to complete, and it seems like it might never end. Strong organizational skills are essential. One of the biggest factors that can reduce the quality of our work is bad multitasking. You might think that you only looked at your phone for a few seconds to respond to a text, but in my view, the research is clear. You will simply not perform as well as you would have if you had your phone turned off. Lately, I have had so much going on, and I’m looking at my phone too much.

We are now preparing to open our second location at Practical Skills Clinic,which requires enormous time and attention. It is time to simplify life a bit. I’ve been publishing this blog twice a week for nearly two years. Life is a series of hellos and goodbyes, I’m afraid it’s time for goodbye again. The blog will publish now and then.

Thanks to everyone who sent me nice notes and comments about blog posts. I have truly appreciated it. I’ve loved writing it.

In the movie It’s a Wonderful Life, when George gets a chance to see what the world would have been like without him, there is a scene where he and the angel Clarence go into Nick’s bar. Clarence has trouble making up his mind about what he wants to drink, and Nick tells him in no uncertain terms about what kind of bar he is in, “We serve hard drinks in here for men who want to get drunk fast.” That’s probably good marketing. Every business needs to know who they are serving. Nick then threatens to beat him up.  It seems like Nick is pissed off that Clarence is so positive.

The scene is the first of many examples showing how awful Bedford Falls would have been if George never would had never been born. All of us have an impact on the world in millions of ways. Nick’s bar is packed. There are lots of people there who want to get drunk fast. I know the feeling of wanting to visit a place like Nick’s bar. After a long day, staff often joke about needing stiff drinks. Pretty much all parents feel like that sometimes, not just parents of children with autism. Probably not just all parents – all people.

The people at Nick’s bar are miserable. Why would they go there? Well, I believe that everyone likes to complain–at least occasionally. Nothing wrong with that. Everyone deserves to complain from time to time. It’s good to have a sympathetic ear. Staff who work with children with autism sometimes need to complain a bit. It can be an extremely challenging job. It would be foolish to try and be positive all the time, no matter what is going on.

Nick, on the other hand, doesn’t want to hear anything positive. He’ll beat you up rather than listen to a positive comment. If you have a “Nick” in your organization, the amount of damage a person like this can do is amazing. A “Nick” can drown out almost any positive. Sometimes we think we can counter the effects of a “Nick” with a bunch of positive “Clarence’s.” You can’t.

Positive influence just doesn’t spread as easily as negative. The negative is dramatic and interesting and it sucks people in. That’s why you rarely see positive stories on the news. “If it bleeds, it leads.” If you have a Nick, the key is to change the behavior quickly or sever ties as soon as possible. The more Nick starts talking to the staff, taking them out for drinks after work, and being a general all-around PITA, the more problems the whole organization is likely to have. One bad apple really can spoil the bunch.

If you are a surgeon and the patient dies, well the operation clearly wasn’t a success. The key item here is it is easy to measure the percentage of patients that died. Now, just because the ­­patient died doesn’t mean that the surgeon did a poor job. Some operations are riskier than others, some patients are sicker than others, and sometimes the patient may not follow post-operative advice. Still, having a clear measurement (death / no death) allows for interesting types of research to occur. For example, it appears that patients are more likely to die if surgical teams have poor teamwork. That’s just one easily measurable outcome. Does anyone doubt that poor teamwork leads to worse outcomes, even for the patients that survive their operation?

Now, fortunately, most BCBAs don’t work under conditions that are life-and-death.  The outcomes are measurable, but unless the service is terrible, it is almost always difficult to assess performance. If a child makes “some” progress, it is hard to determine how much they could have made with a great team. Thus, BCBAs don’t get the type of feedback that surgeons receive, and there isn’t much comparative research on different well-designed procedures.

Since we don’t have much of our own literature on these types of topics, I believe that we can learn a lot from the experiences of others. Anyone who has been part of a great team knows the importance of relationship-building, generating new ideas, communicating critical information, covering during illness, emergencies, or vacations, problem-solving when things don’t go well, ensuring safety, and a host of other possibilities that are difficult to measure. All these things dramatically impact the performance of our clients. That doesn’t even include other non-clinical team members like human resources, billing professionals, and schedulers that can have a huge impact on teams.

Do we do this well in applied behavior analysis? Sometimes. Unfortunately, in some organizations, staff are considered interchangeable parts. There isn’t a lot of thought given to ensuring we have good teamwork. BCBAs love numbers and graphs. It is difficult to measure these types of behaviors, thus it is rarely done. Just because it is difficult to measure doesn’t mean it isn’t extremely important.

I am 15 or 16 years old, walking through the street in New York City. It is a crowded street, and a tourist is walking maybe 10-15 feet in front of me. He is staring up at the tall buildings, slowly walking, carrying many shopping bags from all the fancy stores. I see four men hand signaling, and it seems obvious they are about to target the tourist. What to do? I want to help the tourist, but not sure how. I don’t want these guys angry at me. I end up speeding up, and as I pass the tourist, I say, “Watch where you are Bleeping going!” I pass him, and about ten seconds later, I hear a crash–the tourist is on the ground without his shopping bags. Everyone keeps walking. Welcome to New York.

This is one of those scenarios where better options seem obvious after the fact. People frequently talk about thinking of just the right comeback much later. I could have done much smarter things–strike up a conversation with the tourist, fall in front of him and fake a seizure, or bump into him and start an argument. In the heat of the moment, when you have limited experience, it is hard to know what to do.

Likely, I’ll never experience that situation again. Is there anything to learn from a freak occurrence like that? Yes, even though the same experience is not likely to happen exactly the same way, life repeats a lot more than we realize.

I do experience similar situations all the time. OK, not as dramatically, but frequently, when working with individuals with severe behavior problems, it is easy to see that a problem behavior will likely occur soon. Maybe the child is playing with a toy and can’t get it to work correctly, or the parents run out of the child’s favorite snacks, or a favorite person is leaving the room. There is no problem behavior yet, but pretty much everyone sees it is about to happen.

Often, we think we must respond immediately–Do Something! But our first impulse is often not the best choice. Usually, we have more time than we think. Sure, it is often necessary to respond quickly. But unless there is immediate danger, that doesn’t mean instantly.  Taking just a few seconds to think through your options is often enough to make a dramatically better decision.  Three seconds is a long time. You might have significantly more time than that. This applies to all kinds of stressful, heat-of-the-moment decisions in life. Even in dramatic situations, you usually don’t have to dodge bullets. You have a few seconds. If you can remain calm enough to think clearly, you might save the tourist.

I was in the middle of nowhere in a southern town and wanted pizza. There was an ad in the hotel room, so I called the local place. When they answered, I said, “I’d like one pie for delivery.” He answered, “This is a pizza place. We don’t sell pie.” OK, in that case, I’ll have a pizza.

In New York City, it was common to use the phrase “pizza pie.” We thought it was hysterical that the guy working in the pizza place didn’t understand what I wanted. But why should he? He lives in the middle of nowhere. He probably got off the phone and said to his co-workers, “Can you believe some idiot just called up and tried to have us deliver a pie?” They probably thought it was hysterical.

When working with children with autism, miscommunication is common. One of the most important things we can do is provide crystal-clear communication to the child about what we are trying to teach. If you can do that, half the job of teaching is done.

Unfortunately, it is hard to be extremely clear in our communication. There are almost always multiple ways to interpret a lesson. This was our team’s major insight when we learned how to teach pronouns to children with autism. The standard procedures left a very important part of learning unclear. Specifically, the pronoun that should be used changes based on who is speaking. For example, if the child says, “I want a cookie,” he is referring to himself. When mom says, “Sure, you can have a cookie,” she is also referring to the child, but she uses a different pronoun. That’s awfully confusing. Our small contribution was simply a way to provide crystal-clear communication in that scenario.

If you look carefully, you will usually find that errors made by learners are completely logical from their point of view. Just like it was logical for the kid answering the phone not to understand that we call a “pizza” a “pie” in NY.