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.