POOGI for ABA

Parents, teachers, and other stakeholders are eager for practical information they can use now!  Specifically, they want the answer to the question, “What do I do when he XXX? “What do I do when he screams about doing his homework?” “What do I do at recess when he just walks around the perimeter and doesn’t play with friends?” “What do I do when she lines up items?”

What we say in response to these types of questions is very important for several reasons. First, our response will often largely influence the social validity of the whole intervention. Second, if parents, teachers, or others try our suggestions and they don’t work, they are likely to get discouraged and be resistant in the future. Third, if they take our suggestions and follow them incorrectly, they can make the problem worse than it was before.

Despite how important the answers to these questions are, it isn’t easy to give a clear answer. That’s because of a major conflict in the way behavior change actually works.  Almost all behavioral intervention involves breaking down a big task and teaching it in “baby steps.” For example, if we are working with severe problem behavior, a common first step in the treatment process is teaching a communication response. In most cases, that communication response needs some direct training. That step might take just a few minutes. Then, you proceed to step 2, and on and on, until you have a successful intervention that is practical.

Frequently, when you get the referral for severe problem behavior, the stakeholders expect you to do something about every problem happening – immediately: What do I do in the grocery store, when I drop off at grandma’s house, when washing his hands? From the perspective of the BCBA looking at data on the “baby steps,” things might be going great. Maybe we went through ten baby steps, and everything is going in the right direction. But the person’s life probably isn’t that different yet; the intervention fails the practicality test. We might have some behavior change, but it isn’t effective yet. At this point, we haven’t made a socially significant difference in the child’s life.

There are many helpful actions we can take to improve this situation, including setting clear expectations from the beginning, communicating with stakeholders frequently, and progressing to practical implementation across the day as soon as possible. But one thing that often gets missed is ensuring the stakeholders actually see and understand the step-by-step progress. If intervention happens at school, it is often difficult for parents to observe what’s happening. If intervention happens at home, and parents are working or going shopping during therapy, they don’t see the step-by-step progress that’s happening with the therapists. Sure, progress reports, team meetings, and daily notes might be helpful. But there is no substitute for making sure stakeholders can frequently observe the progress first-hand. Of course, we already know this, but often it can be difficult to make happen.

It can be tough to arrange stakeholder observations for logistical reasons. But logistics are not the sole reason that stakeholders fail to see progress. Sometimes, there are lawyers arguing over how much observation time is appropriate, privacy concerns with other children in schools, organization policy on video, or parents who might be unsatisfied and make critical comments.

COVID-19 almost certainly has many lessons to teach us. Many of us were promoting this idea for years in the “before times,” but it frequently didn’t happen. Now, many families are able to see daily progress since they are receiving all services at home. Sure, it might be uncomfortable when things aren’t going in the desired direction. Sometimes, being uncomfortable is necessary for the Poogi.

Often, we think the biggest opportunities to learn come from formal training. Sure, you might learn something useful at a conference or a workshop. But, although we loathe to admit it, the odds of you being able to return to work and put into practice what you saw at the conference or workshop are low. Usually, you must do a lot of prep work and a lot of follow-up. This might include study, preparation, reading the original research, etc. You should definitely do that, but when Monday morning rolls around and the emergencies start up, it is easy to forget these non-urgent opportunities.

In my view, our biggest opportunities to learn come from the direct feedback we get from our own practice. I learned this from my friend and mentor Alan. Alan isn’t a BCBA, or in the field at all, but he has taught me a lot. He suggests that big opportunities to learn arise when our expectations fail to meet our reality. We implement a behavior change program, organizational behavior management intervention, or other initiative. Of course, we have positive expectations that things will go well. If the intervention rolls out as we expect, it suggests we understood the situation well. But if the situation doesn’t roll out as we expect, there is usually a lot to learn.

If the intervention didn’t achieve the desired results, do we go back and ask, “Why not?” Rarely. But we should. Understanding why an intervention failed leads to big opportunities to learn. Unfortunately, we often just try a different procedure.

Sometimes, the intervention we attempt achieves much better results that we expected. In this case, we might cheer and immediately move on to the next thing. But the fact that the results were so much better than we expected suggests that we did not fully understand the situation. Why was it so much better than expected?

We tend to focus on immediate results. When something isn’t working, we often aren’t that interested in analyzing why we thought it would work, but didn’t. When something works better than we expected, we are too eager to celebrate the success. Anytime we are surprised should be a signal to stop, slow down, and analyze what’s happening. It is a huge opportunity we often miss. Alan teaches how to do this here.

For years, I preached the importance of everyone to be consistent. Now, I’m not so sure it was a good idea. When working with children with problem behavior, typically an assessment is conducted, then the BCBA writes the plan, trains everyone on the plan, and then a day is picked when everyone will implement the plan. Of course, in that type of situation, if people are using different procedures, success is unlikely. Therefore, it is essential that everyone be consistent.

Certainly, that kind of approach can work sometimes. But often, that approach runs into problems. Specifically, three common problems emerge:

Problem 1: In nearly every case, it is not ideal to implement all the procedures at one time. For example, many behavior plans include teaching a communication response so that the child can receive reinforcement in another way besides problem behavior. If a child has problem behavior to gain access to the teacher’s attention, a BCBA might teach the child to say something appropriate like “Can you check my work?”  Now, the teacher might have a whole class of children, and if the child asks too much, it will make the plan impractical. Therefore, eventually the child has to learn that sometimes the teacher will deny the request and you still can’t engage in problem behavior. Usually, those two different lessons–(1) Use communication instead of problem behavior and (2) Communication only works to get what you want some of the time–should be taught separately. If you try to teach them at the same time, success is unlikely.

Problem 2: Idiosyncratic events will distort the team’s focus. For example, if the initial parts of the treatment aren’t done under similar conditions, teams will often lose focus. Today was an assembly, fire drill, grandma was visiting, his brother had friends over, or the neighbor’s dog was barking. Of course, to successfully treat problem behavior, we need to help in a wide variety of situations. But if you don’t focus on the critical aspects of the treatment one step a time, failure is much more likely.

Problem 3: It leads to people getting blamed. When things don’t work, we often don’t consider the most obvious reason the plan was bad or impractical. If you start hearing people say things like, “how can we be expected to be successful when XXX does YYY?” you can be sure you are in trouble. Blaming people for failures is always counterproductive. As BCBAs, we should know better. This causes conflicts between people, mistrust, and general lack of effectiveness.

It usually isn’t critical for everyone to be consistent and do things exactly the same way. Implementing behavior plans in a systematic step-by-step fashion is the procedure of choice. Mom and dad are going to interact differently. The art teacher, para, and principal probably will too. If you plan to try to get everyone to be consistent, failure is much more likely.