Author: Barry Morgenstern

If you ask most people, they will report that they honestly want to improve and do everything they can to continuously Poogi over time. Though they may think they mean it, they often don’t. As I’ve argued before, many of us are overconfident. Simply put, many BCBA’s think that they are better than they really are.

What do most people mean when they say they want to improve? They mean they want ideas that might be called “tweaks.” –Here is a new book with great social skills activities we can add to the mix. This is a new great assessment device that is very helpful in pinpointing skills for activities of daily living. Here is a great tip for initial staff training. In other words, since many of us think we are so great, we don’t think massive improvements are possible. As long as we aren’t a HINIBUS, we are happy to make small changes.

Though many of us work long hours and follow the latest research, we know that not all children have fantastic outcomes. We think we are doing everything possible. But we aren’t.

Sure, we can be happy to accept small changes that are improvements. But if we really want to improve, we have to believe that no matter how good you are, massive improvements are possible. I’ve discussed some of those massive improvements – here and here.

But how can we prove that massive improvements are possible? Maybe what we are doing with our current resources is the best possible? As we know, it is incredibly difficult to measure program quality well. I’m glad that many are trying and I’m hopeful about that research, but as far as I’m aware there is nothing very convincing so far.

Admittedly, my position is not based on science, but faith that science will continually lead us to better answers. But I do know that if you don’t believe it is possible to significantly improve, you will stop trying. If you believe your program doesn’t have massive room for improvements, you are almost certainly wrong.

 

Poogi stands for the Process of On-Going Improvement. Many people think this is just another way of saying, continuous improvement, life-long learning, or other similar phrases. But there is a key difference between POOGI and those similar phrases. That’s the “P” for Process. What does it mean to have a process? We typically think of a “process” as a series of steps used to get a result. In Theory of Constraints, POOGI has a more specific meaning than is beyond my scope for today.

The internet reports that Deming said, “If you can’t describe what you are doing as a process, then you don’t know what you are doing.” I think this is statement is correct. We should be able to describe what we are doing as a process.

When a parent, school district, insurance company, or other person asks us how we will proceed with treatment, the BCBA should be able to clearly describe the step-by-step process we will use. If we can’t do that, it is reasonable to assume that we don’t know what we are doing.

Unfortunately, some BCBA’s don’t have a standard process and so the results are haphazard. Some BCBA’s can describe their process beautifully, but when you observe the actual implementation of the program, you see that those processes are not followed. I’ve seen both. Having a standard process that is used in reality is a key step in building the POOGI for any organization.

Once we have a standard process, we can fight like hell about how to improve the process. We can say, you know what, step 7 sucks. Let’s ditch it. Step 12 occurs too late in the process, let’s move it to step 4. But if you don’t have a standard process, the POOGI becomes impossible.

In my view, that is one of the hidden benefits of the new PFA (Practical Functional Assessment / IISCA) and SBT (Skills Based Treatment) developed by Greg Hanley and colleagues. Before PFA/SBT, there were clearly described processes in the research literature, but very few BCBA’s used them in practice.

The new PFA/SBT process is being used consistently by a very large number of practitioners. Now, we can get down to the POOGI of fighting over the effectiveness of different steps in the process. In the last several years I’ve been working on it, I’ve seen major shifts in many aspects of the process. That’s a great thing. That’s the POOGI.

Maybe Sammy can’t drive 55, but I sure can. I know driving is one of the most dangerous activities I engage in daily. In the United States, we consistently have more than 30,000 deaths every year due to motor vehicle accidents.

30,000 people sound like an enormous number to lose every year due to a trip to the store, going to work, or a visit to grandma. Yet this represents a dramatic reduction in deaths despite a bigger population with more drivers over the last 40-50 years. Probably the reason that there has been such a tremendous amount of improvement is due to advancements in technology like seat belts, airbags, and other innovations. It seems highly unlikely to me that modern drivers are dramatically better than drivers in previous generations.

My question is; can behavior analysts save even more lives by teaching people to consistently drive safer? I know there are behavior analysts that work in traffic safety, and I don’t know much about their work. But I think the first question is: Does society even want us to improve traffic safety?

Initially, most people think “of course.” But what if it meant that cars couldn’t go over 15 miles per hour so your commute increases from one hour to four hours? What if driving was not nearly as much fun after eliminating distractions?

In most activities in life, you cannot eliminate risk. Our goal is usually to keep the benefits while reducing risk as much as possible. In the treatment of people with severe behavior problems, there is always some risk of danger due to the unpredictable situations that may occur. Families are willing to accept some level of risk for the chance of significant life improvements.

We often choose between safety and effectiveness. For example, when we drive, we can go slower for safety or faster to get to work on time. Fortunately for us, recent improvements in the treatment of severe behavior problems developed by Greg Hanley and colleagues have made that decision less difficult. The Practical Functional Assessment (PFA) and Skills-Based Treatment (SBT) process allows us to have a much higher level of safety while still effectively improving outcomes for children.

 

In programs based on Applied Behavior Analysis, it is fairly rare for the BCBA to be the one working directly with the client. In the vast majority of situations, the BCBA is acting as a consultant or supervisor to a parent, paraprofessional, Registered Behavior Technician (RBT), or teacher guiding how to implement behavior change programs.

The BCBA typically will have a written document that explains how to implement the behavior change program. Then the BCBA does training on the implementation of the plan, ensures the integrity of the implementation through observation, provides both positive and negative feedback to implementers, reviews the data, problem solves when the data do not show progress in the desired direction and makes appropriate adjustments to the plan if needed.

Most people with experience will realize it virtually never works like that in reality. One basic problem with this traditional view is that it makes it sound like the BCBA makes all the decisions. If you aren’t getting feedback on what can be improved from the people implementing it, the program will be weak. Making those decisions needs to be a collaborative process. But should the BCBA even be consulted on routine day to day decisions?

Some BCBA’s want to be involved in every single decision. The program says he gets to play with trains as a reinforcer, but today he wanted to color. Is that allowed? Should the prompt be delivered after two seconds or five seconds? Some days he is very distracted by looking out the window, can I close the blinds? As a general rule, if the staff doesn’t have enough training to handle daily routine decisions, the program is likely of poor quality and progress is sure to be very slow.

On the other hand, there are BCBA’s that try to stay out of the insignificant details. They try to focus on teaching the basic behavioral principles and let the people implementing apply those principles. That can certainly work, sometimes. But there are terrible programs where the BCBA is overloaded with too many cases and staff are making decisions all the time without sufficient training. They don’t understand the basics well enough to make good decisions. This often has disastrous results.

Every time a BCBA supervises a program, there is an essential decision to make. How much autonomy do I allow from the implementers? There might be a variety of factors involved in making that decision. Things like the experience and training of the implementer, how often the BCBA will see the client, the complexity of the procedures, safety issues, among others. Both too little autonomy and too much autonomy will likely lead to terrible results.

In my view, this one decision often results in how successful a program is likely to be. Think it through carefully.

People Magazine has never named me the sexiest man alive, even when I was younger. ¹ I’m only mildly disappointed by their oversight. It hasn’t had a substantial impact on my life to this point. I’m sure I could improve, but I’m not focused on it.

Every aspect of our work and personal life can be substantially improved. We can improve supervision, report writing, training, scheduling, data collection, and every other aspect of our work. No child’s program is perfect; we can improve assessment, teaching procedures, organization of materials, and every aspect of a child’s program. We can all improve our diets, exercise, sleep, relationships, and finances.

Poogi (The Process of On-Going Improvement) does NOT mean improving everything all the time. That’s a sure way to have poor results. You simply cannot focus on everything. The good news is that you don’t have to. First, you have to select a reasonable goal that isn’t completely out of reach, which is sometimes a problem in applied behavior analysis. Second, only try to improve one or two areas at a time. That’s plenty.

Often, an improvement in one or two areas can lead to huge improvements in many areas. For example, if you improve problem behaviors, often language, social skills, academics, and self-help improve too. If we improve supervision, often employee morale, turnover, and client results also improve.

Of course, if you have a long enough time horizon most goals become possible. Does People Magazine have an over-80 category?

¹ The ethical code of the BACB (8.01) requires that BCBA’s ensure that they do not make public false statements. Therefore, on this blog, I attempt to make sure that all statements are thoroughly fact-checked. In this case, due to time constraints I did not check People Magazine to ensure the accuracy of this statement.