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Breaking Down Barriers: Understanding Applied Behavior Analysis and Its Impact on Children
Crystal Collette and Jennifer Watson Jamison share their journey to achieving Autism Commission on Quality accreditation for Centra's Applied Behavioral Analysis therapy program and explain how modern ABA helps children with autism through individualized, evidence-based approaches.
What exactly is ABA therapy? As Jennifer explains, it's fundamentally "the science of learning" that addresses everything from communication and social skills to emotional regulation and self-help abilities. Modern approaches have moved away from older error-based methods to "errorless teaching," where children are shown the correct response from the beginning, resulting in faster learning and less frustration.
For parents feeling overwhelmed by an autism diagnosis, the team offers this reassurance: "Take a breath... We're in this together. We will figure it out." Visit Centra's website to learn more about autism services and take that first step toward understanding if ABA might be right for your child.
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Hi and welcome to, and so Much More I'm that our Autism and Development Services team has received for ABA therapy, and that was a lot of information that I just threw at you and so just to kind of lay that groundwork, that's what started this conversation. We're excited about this accreditation and it's ACQ we just had to work on well, I had to work on that, but you know Autism Commission on Quality, and so I want you guys to tell me a little bit about all of these things. But first, why don't you introduce yourself? I have Crystal and Jennifer and I'll let you guys talk about what it is you do here at Centra and then the team that you're on.
Speaker 2:Sure, so I'm Crystal Collette. I serve as Senior Director of Psychiatry and Behavioral Health for Centra, with primary oversight for our child outpatient behavioral services, which includes our autism and developmental clinic.
Speaker 3:And I'm Jennifer Watson-Jameson. I am the Lead Licensed Behavior Analyst with the clinic at Centra and I lead our applied behavior analysis team at the clinic.
Speaker 1:So tell me about this accreditation, because and I don't want to steal any thunder here, but I love what you were sharing it's not a this is not a required accreditation. This is just the Centra team pursuing something because they want our services to be that much more top notch. So tell us about ACQ. What is it? Why should we be excited about it?
Speaker 2:Yeah, Well, this has been a labor of love for Jen and I for close to two years.
Speaker 2:We first heard about this accreditation because we are a part of a trade organization, Council of Autism Service Providers, or CASP for short. Jen actually helped to develop organizational standards for ABA organizations and ACQ, or Autism Commission on Quality, was actually born out of CASP developing these organizational standards out of the recognition that there needs to be some type of quality measure to make sure that individuals with autism and their families are accessing really high quality ABA services. There's a lot of ABA service providers out there and so ACQ was created. It's a nonprofit organization accrediting body pursue the accreditation for that recognition and to make sure that our families and the individuals that we work with were receiving quality care. It was good for us to confirm that what we were are in fact doing the right thing and quality care, but absolutely a celebration and a testament to the work that our team does to provide quality care.
Speaker 1:Yeah, and two years in the work Congratulations. I had no idea all that went into it. So tell me about ABA therapy as a whole. So these observations that were happening, these clinical interviews, but also these family interviews, what were they there to observe and why? Yeah.
Speaker 3:What was? What were the?
Speaker 1:like? What is ABA therapy Like and why is it so important to show people that we are raising our standards in this area of care?
Speaker 3:So ABA has been around for about 60, 70 years now, from the from the very start. The reason it's so pertinent now is because we're still young in the field. Aba is still considered one of the the younger sciences. We're still young in the field. Aba is still considered one of the younger sciences. It is a science. It's not just a matter of kind of just throwing things out there and seeing what sticks. We rely on our data. Aba is really the science of learning. It is how everyone learns Everyone. From the time that you're born, you know you interact with your environment in different ways and then you either find out, hey, that works for me or hey, that doesn't work for me, and you change your behavior based on your reinforcement that you get back from that. So it really is how everyone learns. But specifically for our clinic and for working with children with autism, it's teaching them the way that they learn, so breaking things down into smaller components and helping them learn in that way.
Speaker 1:So you said this is kind of young in this field but, it has evolved over time so what does that evolution look like so far?
Speaker 3:So there's a lot more research in our field now, and one of the phrases I like to tell families, and tell professionals that I work with too, is when you know better, you do better. And tell professionals that I work with too is when you know better, you do better.
Speaker 3:So we've come a long way in knowing that some of those the the kinds of strategies that we used before weren't the most effective for the children that we were using. We found better ways to do that. A good example is when I was first in the field and I feel like I've been there for a while we used to do something called no no prompt, which is what we would present something the child would answer incorrectly. We'd say no, we'd present again. The child didn't answer incorrectly we'd say no.
Speaker 3:And then the third time we presented we would actually prompt them, and what we found is that it gave the child a chance to make two errors and then get it right. We prompted them to get it right. What we've learned is why do they need to make two errors? Like we teach it right from the beginning. Now we use something called errorless teaching, where we teach from the beginning and show them hey, this is what I want you to do. There's less frustration, there's less behaviors and the child learns quicker.
Speaker 1:Yeah Well, and that makes sense, I mean, if you're going to have to see how it works over time. And so it's encouraging to see, especially with a specific example like that, where you saw that maybe something wasn't as beneficial and you were able to adjust. That's probably really good. I know it's good for me as a parent to hear um. So what types of challenges specifically does this address? Or and maybe that's too specific of a question, because it sounds like there's quite a lot um, but when, like what would a session look like?
Speaker 3:okay, so two separate questions. So what kind of challenges? What they address? So we and I did have notes, so we address things. Everything from you know cognitive functioning, executive functioning, self-help skills, emotional regulation, self-regulation, self-management, social skills, language and communication is huge for what we teach and all of that kind of goes together as well. And that's not, that's a not a comprehensive list, but that's certainly a good start. So when you think about behaviors and human behavior, there's really so much and it's so complex because they all interact together. So while I'm teaching you know communication and functional language, I may also be teaching a child to ask for something they want or tell us that they don't want something else. So those kind of things. And then what was your second question?
Speaker 1:So the second question was what like? What would a specific case look like? And you kind of told us it with that one example. But if someone's like, I want to picture myself in the room with my child.
Speaker 3:So we do, we, we, we do get that a lot and what we generally will do is say come watch us. A lot of times when people watch us, they say you look like you're playing.
Speaker 1:I'm like, yeah, we should be looking like we're having a good time.
Speaker 3:Like. That's the whole point of it is that there is a lot of reinforcement that happens. There is a lot of pairing, there is a lot of relationship building that happens within ABA. We, you know, we try to structure the session so that there is a balance of things that we're working for, things that we're working on with the child specific goals that we're working for, or things that we're working on with the child-specific goals that we're working on, and then some time for reinforcement, or time for leisure, or time for fun things Because again if you're.
Speaker 3:You know this, everybody knows this if you're not engaging in something fun, it's far more work. Oh yeah, so building those relationships and having that relationship with the child and the family is very important to us.
Speaker 1:Yeah.
Speaker 2:I would add too, the. I think the other thing about AB2 is it's so individualized.
Speaker 3:Yes.
Speaker 2:No two treatment plans are going to look the same.
Speaker 1:Yeah.
Speaker 2:And that is part of having that really quality. High quality of care is that we are, you know our behavior analysts are doing assessments and making sure that each individual child is getting exactly what they need even if two children are working on similar skills, they're probably not even you know, maybe even using the same procedures to work on those skills, because it's based on what that child and really that family needs. We take cultural, you know things into consideration. You know what the family might want their child to learn, or do so very highly individualized.
Speaker 1:Yeah.
Speaker 3:That's a good point too, because when we're making sure that we're doing a treatment plan for a child and Crystal mentioned, you know, making sure that we're doing a treatment plan for a child, and crystal mentioned, you know, considerations the family, not only it, it is what's important to them, because and I tell parents this all the time what we do in aba is not, we're not behind a magic door.
Speaker 3:We don't want to be in this place where, where they don't know what we're doing, because we want that to be carried over and generalized. That's where they're going to be using the skills is, at home, in the community, in school. We want them to be able to do those things in other environments. So, please, you know, we have ways of having families in sessions with us. We have families in session with us. Sometimes they'll be outside of the door with us, you know, talking with the BCBA, and we'll be talking about things that we're doing, procedures that we're doing in the room. Families are always welcome, though, and very much our entire clinic is very much open door policy. Please come in anytime, come watch us, come observe.
Speaker 1:That is so encouraging and talk, yeah, yeah. So what are some of the proven benefits that you have seen? And you can answer this like proven benefits of ABA as a whole or even just what? Are the benefits or the outcomes you have seen at the center.
Speaker 3:So there's a whole body of research on the benefit of ABA and actually CAST just put out a paper detailing the benefits of applied behavior analysis therapy for parents and for practitioners and how I like the way the paper broke it down into the different amounts of treatment, the treatment hours that you can have versus the intensive therapy, and where that's appropriate. That may not be appropriate for every child and how is that appropriate for them. So there's a good paper on that that I can I can give you that resource as well.
Speaker 1:I can make that available in the description for those of you who are watching, because it really is great information and I was just kind of pouring through it before you guys arrived and it's so helpful and, like so much of what you're saying, I can just like see these boxes being checked in my head, like it looks like play. Parents and families are welcome to come in, yes, to observe, to just find out if it's good for you, but then for your own child, like this is not some like behind closed doors, like we're here to help your child and then they disappear and it's so encouraging and I think it really does welcome people in to the process.
Speaker 1:And so, if you can and I know we can't share like patient names- or anything, but is there like a success story that stands out to you, that you could share?
Speaker 3:So there are a few. Yes absolutely we had. One of my most significant experiences at the clinic was when I had first started there. It's been 10 years now, actually almost 11, but yeah, 10 years and we had a child come in for an assessment a young child and they were nonverbal at that point. Parents were kind of seeking services and more concerned about communication and when we were doing the assessment we got them to elicit their first meaningful babble and asking for bubbles from us.
Speaker 3:So we got the child to imitate us and and was able to get bubbles, and that was amazing, and it was. It was not only amazing for me, but it was also. The family saw it and we could repeat it. So it happened again and again and the parents were like, oh my gosh, this is real, this isn't just a fluke, this is, they really did it. So it happened again and again and the parents were like, oh my gosh, this is real, this isn't just a fluke, this is, they really did that. So that was really, that was an amazing experience.
Speaker 3:And then, um, I also asked my colleague, um, who works with me in the clinic, if they had any, um, meaningful examples as well. And they had mentioned, um, that one particular child that they had seen had come in with some severe self-injurious behavior due to a lack of communication as well, no social skills whatsoever, would engage in a lot of pacing back and forth in the room, but was not interested in us, was not interested in the toys in the room. It was just kind of I'm in here with you, but that's it. It was just kind of I'm in here with you, but that's it. And that child, through very successive approximation changes in behavior, is now communicating, not only starting with a voice output device, but is now communicating with words and speaking and is getting ready to transition into school and actually out of ABA.
Speaker 3:Wow, they're graduating from ABA. That is amazing. So we've alleviated those behaviors and transitioned into into what they needed, what that family needed.
Speaker 1:That's incredible and and in those moments like it's hard to not get emotional as you tell these stories, because you, you think these moments will never come as a parent and and to see something work is huge. And to see something work is huge, and so I hesitate to ask this question, but it's important because, hearing these stories, you're like wow, this is amazing. But there is some controversy out there. There are some families and some neurodivergent individuals who are stepping into autonomy and are like whoa, this is?
Speaker 1:and some even say inhumane, like this is this is concerning this is, you know, putting people in a box and um. So what would you say to those concerns as and what we can approach it however you want to approach it, because, again, it's such a variety like you can't address every single concern. But for those who are like, it's such a variety Like you can't address every single concern.
Speaker 3:But for those who are like what are the cons? I think that, like again what I've said before, when you know better, you do better. Yeah, I think those individuals absolutely have the right to feel that way and express their opinions and I think it's so relevant and appropriate and needed in our field for us to hear from those individuals. I don't negate that at all. We welcome that input to our therapy. There are going to be some families or some children that ABA is not a fit for them, for whatever reason. It could be for a variety of reasons.
Speaker 3:What I would encourage parents and adults, children, whoever the patients who are engaging with us voice your concerns. If you feel that you have concerns about something that is happening in therapy or that you may, you know, have questions about, ask those questions. Ask your provider. I have always, as I've supervised, you know, behavior analysts in the past, I've told them you should always be able to explain what you're doing that's just good practice and explain why, the why behind what you're doing. You know, please ask questions and have that conversation. I will say you know, people have different experiences with all kinds of things. So, yeah, just being open and honest, I think, is the best way to approach that.
Speaker 1:So a parent comes in and the door is wide open, opportunities there for them to ask any question they want. Watch with their own eyes what this is going to play out and how this is going to look. So what is the case? Has there ever been a case where ABA therapy was not the right choice for that child?
Speaker 3:There have been some. The other thing I need to be clear about is that ABA is not just for children with autism or that particular diagnosis. Aba serves a wide variety and population of people, and even two of the biggest movements in ABA right now are gerontology, actually, and health and fitness, which is surprising, you wouldn't think so, but it is yes. So I would be amiss if I didn't mention that as well. It's much bigger than autism.
Speaker 1:That is so interesting.
Speaker 3:Yes, but if there are patients that we see that this is a big time commitment for a family, I would say is one of our biggest issues that we have and we do ask for and you'll see in the cast paper that I mentioned, you know we ask for a minimum number of hours to be able to see their patient, based on their assessment and their needs.
Speaker 3:And it varies from patient to patient, as Crystal mentioned before. But sometimes that's not. A family can't commit to those hours and that's okay that they. You have to find what suits your family and what works best for you at that time. I will say that doesn't mean that ABA and time isn't the only thing, but it doesn't mean that ABA isn't good forever or maybe it wasn't the right fit or whatever. It's just not right for right now.
Speaker 3:There are some children that come to us that have a lot, a wide variety of skills and maybe it's that social deficit that they have difficulty with. Or, as our children learn the basic foundational skills that we need that we're working with them in intensive therapy. They may need additional counseling and we can refer to that. Or you know we do refer to other providers as well. We're very collaborative with who we work with um and talking with. You know, if they have issues with um sensory integration for example I would consult with an occupational therapist or refer to occupational therapy. Most of the time when we have children who have speech, language, communication delays, we will refer to speech as well. Okay, there may be times when we say you know what? Aba isn't the right choice. Start with this other therapy first, maybe, or that's where I would guide you. Yeah, and then come back to us later. Can you think of any other times?
Speaker 2:no, I think you covered it. I mean the time commitment does seem to be sometimes the hardest part, because it isn't like going to the doctor once a month for like a med check or seeing your counselor once a week for 30 to 45 minutes, and I think you know, understanding that from the beginning, which we try to be very clear with families about that. And, like Jen said, you know, just because it doesn't work right now doesn't mean that it won't work in the future.
Speaker 3:Yeah, or if families get, if they graduate, as we call it, from ABA. They may need to come back later. Yeah, you know, it's not a one and done kind of thing. We can reevaluate at a different time, and that's okay.
Speaker 1:Yeah. So to the parent or the family or the caretaker who is overwhelmed and they come in, what, what would be your message to them? Take a breath.
Speaker 3:That's probably the biggest thing and that, um, we'll figure it out. We're in this together. We will figure it out. We will. We will take it apart piece by piece and look at this Um, have families that will tell me I just don't know what to do. I don't know what to do and I'm like well, that's why you're here, that's why we're here with you, that's why we work with you. We'll get through it.
Speaker 2:It's a team, effort. I would add too I think our ABA team are cheerleaders for the smallest victories.
Speaker 2:So I think my advice would be celebrate those really small victories. You know, not everything needs to. We don't need to wait till some huge milestone to celebrate. And you know, I think one of the most joyous things about walking into the clinic is just the the happiness of the kids coming in, but the staff too. I mean they're having fun at work and getting to play and do fun things. Yes, and celebrating those really seemingly small but to us really big wins, yeah, with the kids, yeah absolutely so.
Speaker 1:You have a team that is here to help you make the right decision, and I think that is something that is really important to take away from this conversation.
Speaker 1:For those of you who are listening. You don't have to have the yes, this is the right option for me nailed down when you come in. Just take that first step of curiosity, of wonder, like can this be a good fit, and then just be open to it. Thank you guys so much. This is such good information. I hope that those of you who are listening can walk away with this and feel just a little bit more informed and like you have a little bit more at your disposal and please check out the information that we're going to put in the description and then, if you have any other questions, head to our website. And we have the Autism and Developmental Services webpage, psychiatry and Behavioral Health webpage. All of that is grouped together with some incredible information for you guys to check out. So thank you and thank you for watching on and so Much More.
