The Importance of Second Opinions
A parent recently called me for advice. The problem the family was facing is that they were losing their current services due to changes in funding. The family would no longer have their current BCBA and team, with whom the parents thought the child had made excellent progress. Now, there would be a new BCBA and a new team. The parent was extremely concerned. These services would occur at a school, so it wouldn’t be easy to observe. How will she know if the school-based BCBA and school staff are doing a good job?
In my experience, the parent is definitely justified in being concerned about this problem. I have seen great services delivered in school systems, and I’ve seen terrible services delivered in school systems. Of course, sometimes the answer is obvious. For example, if there are frequent safety issues due to dangerous problem behaviors, that is a warning sign that there is likely something wrong with the services. On the other hand, if the child is making friends, getting good grades, and doing well on standardized tests, that is pretty obvious something is going right. But usually it isn’t so simple. As a parent, it isn’t always easy to tell the difference between low quality and high quality.
Sometimes, people will suggest looking at the data. That is certainly helpful, but insufficient for numerous reasons that I’ve discussed frequently on this blog. Even an expert can’t really evaluate the program quality by simply looking at data, even if there are no misleading aspects of the data and it was collected with perfect accuracy, which is NEVER the case.
Sometimes, people will suggest asking other parents. That is helpful too, but also insufficient. Parent reports are often good indicators, but certainly not always. Several times I remember doing an evaluation where I thought the services were of very low quality, yet the parents were completely satisfied. Other times, I’ve seen parents upset with the quality when in my view the services were excellent.
Sometimes, people will suggest looking at how services are generalizing to home. This can be very helpful. If you are seeing generalization to home, that’s certainly a great sign. But the lack of generalization could be caused by a lot of potential factors. Certainly, the problem should be addressed, but it isn’t possible to draw a straight conclusion that services are poor based on this evidence alone.
In my view, this is an area where parents frequently need a second opinion. I often suggest that parents have an independent outside expert BCBA provide an evaluation of the program. This offers several advantages. First, it allows parents to get a realistic picture of the quality of the services. Second, even if the services are of high quality, there is always room for Poogi. Having another set of eyes can often lead to great ideas for further improvements. Third, unfortunately, the way the world works is that is that the “squeaky wheel gets the grease.” Often, schools have limited resources. Simply having an outside evaluator come in to review a program can improve the quality. Fourth, if the program is of low quality, you have the opportunity to make changes early and get started on a POOGI.
It is important to pick the right type of expert. You are looking for someone who will give an honest opinion. I’ve seen some evaluations that are from parent advocates, basically echoing whatever the parents want them to write in the report. In a similar manner, I’ve seen some evaluators that will pretty much put in whatever the school district wants them to say. Usually, these aren’t BCBA’s who must adhere to our ethical code.
Unfortunately, it isn’t always easy to find an expert to do this type of work. At least in Connecticut, where I live, I know people who do an excellent job providing these types of services are often booked months or years in advance. We need more people doing this type of work. If you live in Connecticut, contact me if you need a recommendation. But realistically, there are long waiting lists for all the excellent evaluators.