POOGI for ABA

About 30 years ago, I went out with a few friends to a honky-tonk bar in a southern town. The unique feature of this bar was a mechanical bull ride in the middle of the place. I had no intention of trying it, but one cowboy after the next was taking a turn–it seemed easy and fun. Everyone was having a good time, so I got on the mechanical bull expecting to be a natural like Gene Wilder trying it for the first time. Unfortunately, I wasn’t. I fell off quickly, which resulted in a trip to the hospital with a busted ankle.

Riding a mechanical bull is a skill that has to be developed. The problem is that it sure looked pretty easy. Some skills don’t look easy. No one without training expects to be able to replicate what a skilled gymnast can do. Most people see the incredible flips and assume it would be impossible to replicate those moves.

When skills look easy, it encourages people to be overconfident and take a turn on the mechanical bull. It seems to me that Applied Behavior Analysis is more like riding a mechanical bull than being a gymnast. People observe what the BCBA does and immediately think, “I can do that.” The problem is there is usually no busted ankle to let them know they have no idea what they are doing. It is easy to fool yourself into thinking you are doing great when you aren’t. A major cause of failure is that people assume they will be able to do it with minimal training – it just looks easy.

In a way, that’s positive. Sometimes parents and teachers are so frustrated that even after they watch you successfully work with a child, they still think it won’t work for them. That’s usually fairly easy to overcome, though. The person harder to train is the one who thinks they already know everything.

Another problem I’ve run into is sometimes the parent or teacher we are training acts super confident. That will sometimes fool me into thinking that the full training isn’t needed. Most of the time, the skills we teach are hard enough to require some practice, and without sufficient practice, failure is likely. But most skills are not so hard that the average parent or teacher can’t acquire them in a reasonable amount of time.

My brother and I broke the nice coffee table in my parent’s living room when we were kids. My dad bought one at a garage sale for $3 that we could use temporarily until we got something better.

 

About 15 or 20 years later, I was moving in with Cheryl and took the $3 coffee table to our apartment and the two places we lived next.

 

Our next move was across the country, so we decided to sell all our old furniture. We had acquired quite a bit of 2nd hand furniture by this point. A guy from Discount Furniture came to look at our stuff, and said he would take everything but the coffee table. Finally, I had to give it up.

 

Often, we think because things are old, they are no longer useful. This is particularly true with research studies. People don’t want to look at anything published more than a few years ago. I was recently working with a child with autism using the latest research. Things were going very well, but we weren’t getting the desired effect. After much tweaking, we added a component directly out of 1960s JABA, which led to an amazingly successful result.

 

When we look at the newest research, there are likely new insights for practice that we can glean from those results. Integrating new results into what came before is sometimes a difficult process–but well worth the effort required.

Recently, I visited my mom in the hospital on a unit that specializes in patients with cancer. Hospitals are currently experiencing staffing shortages, and it was clear the nurses on this unit were overwhelmed. But despite this, 24-hours a day, a line of nurses sat in front of their computers entering data. The famous surgeon and author Dr. Atul Gawande complains he spends more time in front of his computer than seeing patients–“I’m a glorified data-entry clerk.” From what I saw, so are the nurses.

In general, I found the nurses at the hospital to be incredibly caring, wonderful people trying to do their best under incredibly difficult conditions. But a bad system will beat a good person every time. As a behavior analyst, I instantly think in terms of contingencies. I’m sure the nurses are under tremendous pressure to input everything just right on the computers so that the hospital can bill insurance companies. And, I’m sure it is also helpful to have good documentation of medications and treatments for clinical care. Yet, it seems clear that they could dramatically improve care if the nurses spent more time with the patients and less time on their computers.

As an old BCBA, I remember the days of sitting down after work to document client progress with a pencil and graph paper. We used paper data sheets, mechanical counters, stopwatches, and timers during sessions. Sure, it was a hassle to graph the data after sessions, but in general, it worked. Now, we have electronic data collection systems that were supposed to save time, but in some cases, make things worse. Even before electronic data was a factor, we knew that collecting too much data could hinder client progress if it disrupted using the best procedures available. A data collection system that requires nurses to spend so much time on their computers violates that rule– it forces the nurses to focus on the data much more than the patients. Wonderful people in a terrible system will surely lead to burnout.

I’m not so old that I’m complaining about all this newfangled technology. I understand the huge benefits technology has already given us and how much more is possible. I know that the good ‘ole days weren’t always good, and tomorrow ain’t as bad as it seems.

I admit I felt a little better hearing that a prominent physician such as Dr. Atul Gawande struggles with this issue, too. I believe significant improvements in the available technology would lead to substantial POOGI for BCBAs and the medical field.