Call the Plumber

Previously, I’ve discussed how there are large reinforcers for staff to make sure children make excellent progress, and punishers when children don’t make progress. The quality of the program is directly related to staff satisfaction. Although I don’t have the data to prove it, I believe children not making good progress is one of the main causes of staff burnout, turnover, and general dissatisfaction. I know, I know- staff complain about a lot of things; salary, benefits, commute times, nasty managers, difficult parents, and uncomfortable chairs. Do everything you can to fix the other problems, but if you miss on the program quality measure, you have no chance of keeping strong staff around.

Now, even the highest quality program will have children who don’t do well from time to time. That should be a major concern for managers. We should realize that even though no one planned it, working with a child who is making very little progress is likely to be highly punishing for staff. It does not matter if you “provide support,” “spend time with them,” or “try something different.” It doesn’t matter that you are reassuring them that it is not their fault and praising their attempts at teaching or implementing a behavior plan. Either the problem is fixed or the problem is not fixed. The staff person and the parents are the people who will be with the child for long periods of time each day.  If a staff person is coming to work frustrated that the child, they are working with is not progressing day in and day out, it is only a matter of time before they start looking for another job, or even getting out of the field altogether. This happens everywhere from time to time. What to do? Call the Plumber.

Plumbers are problem solvers. When your toilet is overflowing, you don’t want to hear that they can come see your problem a week from Tuesday. You want someone who can come fix the problem now.

Every organization needs some high-level plumbers who can walk the walk. When things inevitably go wrong from time to time, do the staff have someone they can call? When they call that person, does the person get to see them quickly? When the person sees them, do they actually help fix the problem and get the child on the road to strong progress again?

We should try to not act like plumbers most of the time. If you are always plumbing, there is a fundamental problem in the system. Most of the time, we should be doing thoughtful analytic work. But the toilet overflows everywhere from time to time. Make sure that there is someone to call who can help quickly, or those staff and parents are likely to be extremely dissatisfied.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

You’re so Vain. I Bet You Think This Blog is About You, Don’t You? Don’t you?

One Year Anniversary Post

Since I began writing this blog, several people have asked me if a particular post is about them. Carly admitted that her song was a composite of several people. I thought it was worth addressing how I refer to other people on my blog.

Here are the basic rules I use:

Sometimes what I’m describing is a composite of different situations that I’ve seen again and again, and typically don’t represent a specific person. In that case, I’ll say things like, “Let’s say I’m working a child who…”

If I’m talking about a specific case, I typically say so as in “One time I was working with a child who…” Of course, memory is fallible, and sometimes I’m writing about events years or decades later, so some of the details are probably wrong. Also, I disguise some of the details to protect both confidentiality and the guilty. In spite of this, I strongly believe the message is accurate.

But mostly, I’m talking about my own mistakes. I have frequently given a presentation titled, “I’ve Made All the Mistakes So You Don’t Have To.” The old saying goes that a smart person learns from his own mistakes, but a wise person learns from the mistakes of others.” I consider myself smart – but not very wise. Typically, until I try it and fail, I tend not to learn the lesson.

 

In our field, it isn’t particularly easy to be wise. Sure, we have lots of training, workshops, journal articles, and conferences. But mostly, those discuss successes. There is very little discussion of failed cases and the reasons behind the failed cases. There is even a formal name for this bias – the file drawer effect. Successful cases get published, while failures are often hidden. I see that as my opportunity to contribute. We now have thousands and thousands of new BCBAs. My sincere hope is that these smart people become a bit wiser by reading the blog.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

“If you measure my behavior in illogical ways, don’t complain about my illogical behavior”*

The federal government has implemented a poorly designed pay-for-performance system in health care. Specifically, the government set standards for patient outcomes that are directly tied to Medicare funding. Also, the ratings are very important for the hospitals’ reputation and standing in the community. As a result, hospitals started throwing out donated organs that weren’t perfect. They began refusing to operate on severely ill patients. Because if the hospital were to take those types of risks, their success rate would decrease, and so might their government funding. These contingencies put hospitals in an impossible situation. Doing the right thing could potentially hurt the hospitals’ ratings, reputation, and income.

Although this phenomenon is not widely recognized by BCBAs, there is a lot of research on this topic. A few examples are this book, or another recent one, or in the field of economics. In my view, they are worth studying because similar unintended outcomes frequently occur when BCBAs attempt to implement OBM-type systems, although not as dramatically as in hospitals. On this blog, I’ve talked about this problem in several areas like:

I’ve attended many trainings and read lots of books and articles on organizational behavior management (OBM.) The concepts seem so easy to understand; anyone should be able to do it. Yet, if you look into the details of how OBM is implemented in many organizations, it often leads to unexpected negative outcomes. The problem is that these negative outcomes aren’t usually captured in the measurement system, so everyone is celebrating a failed program that looks successful.

One simple question every BCBA should ask before implementing a new OBM system:

Is there any way that this measure can be improved while doing something that is not in the best interest of the client?

If so, we should either:

(a) Eliminate that measurement, or

(b) Add other measurements that ensure that the negative effect won’t happen.

*The title is a quote from Eli Goldratt – author of The Goal

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.