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.