Once I was involved in the long-term treatment of a child with severe behavior problems. The treatment was by all measures a huge success:
- Problem behavior reduced to zero for several years.
- Huge increases in language, social skills, academics, and general education participation.
- Strong generalization–able to work with many different people who had received training.
- Parent training was conducted, and the student was very successful at home.
- Behavior plan was very complex initially, and then faded to a very simple, practical, and easy to implement plan.
- Very high satisfaction among teachers, therapists, school district leaders, and parents.
- The student was improving in a wide variety of language and academic skills programs.
After a few years, the child lost funding. A new team took over to reduce costs. We had warned the new BCBA that the new therapist had inadequate training. Within three months, severe behavior problems had returned. I had the opportunity to see this child 3-5 years later when the student was placed in a segregated school that served children with severe behavior problems. It was apparent that the behavior was so severe at this point that it was likely to be life-long problem.
For many years after this experience, I questioned “what else could I have done?” If the funding source reduces expenses and puts a low-quality team in place, nothing can be done about that. Not my fault. Right? Wrong. It is easy to blame the team that took over. Why didn’t the new BCBAs do X, Y, and Z? But that’s the wrong approach to the POOGI. Now I understand I could have done a lot better.
The problem was I was fooled by my own data. A review of the data by traditional standards made the program very hard to criticize. But I wasn’t doing the right thing in this case despite what the data showed. This was a student with severe behavior problems, and there were still contrived contingencies in place. We did a lot of work on making those contingencies more natural, but we weren’t there yet. As we know, if a behavior doesn’t work with natural contingencies, it is only a matter of time before the behavior comes back.
But what was I doing? I was helping the team teach high level language skills, reading skills, math skills, and eating independently with peers in the school cafeteria. That’s what everyone was concerned about at the time. Plus, there had been no serious behavior problems for years. What I could have done is introduced some maintenance challenges. That might have showed the team (and me!) what was really important. I can tell you no one cares about any of that now. The only thing that matters is what maintains over time.
I believe this story also demonstrates another problem we have as BCBAs. You can work on the wrong things, and still look really good for a very long time. I have seen this many, many times before. Only if you are focused on the client’s continued success after you are no longer working with him or her are you likely to choose the right goals.