Process Means Success: A Winning Formula For BCBA Consultations
I’m a big 80-20 rule guy. Some of you have figured that out by now. I find the concept fascinating as well as useful.
Just about everything we do—every task that we perform—has pieces to it that far outweigh the others. There are component skills, or component behaviors, for everything. The more we engage in and become skilled in those behaviors, we drastically increase our probability of success at whatever that task might be.
For example, becoming fluent at using a brake pedal, accelerator, steering wheel, seat belt, and reading traffic signs drastically improves your driving abilities. If a driver isn’t fluent in just one of these skill areas, you can imagine how dangerous it would be.
Understanding concepts like the dangers of under cooked meat or the appropriate ways to operate around high heat are essential to having a cook out. Screw up in these two areas, your party can get dangerous fast.
No matter what the activity or task is that you are trying to accomplish, there is always a hierarchy of behaviors that improve the outcomes dramatically, should they be engaged in.
Conducting a consultation with a learner and their RBT is no different.
That’s why today I’m tackling some of the key behaviors that we can engage in to drastically improve our consultations with learners and their RBTs.
What behaviors or sequence of behaviors will make your consultation a quality one?
Well, let’s get started…
Prep. For those of you that subscribe, you might have read last week’s article on what one can do before they enter consultation with a learner. Data is a miraculous, incredible thing. It not only allows us to make informed decisions, but it also gives us a way to observe a learner from a distance. Meaning, we should be looking at data before we go into the consultations. We should already know which programs might be ready for mastery, are stagnant, or are ready for next steps.
Inquire broadly. We forget this sometimes but RBTs are clinicians, too. They’re stakeholders. They care. They have ideas. The first thing a BCBA should do when starting their consultation revolves around their relationship with the RBT. On a broad level, sit down and ask them about themselves and how things are going with the learner in general. Ask a lot of questions. A lot! Your job at this point in time isn’t to provide answers or solve problems. It’s to garner information on how the RBT is doing with the learner specifically. Are they pumped? Are they tiring? Do they feel like progress is being made? What stands out to them as major areas for improvement? What is going right? What ideas do they have?
Take notes. This is the part where they talk and your goal is to keep them talking. Figure out where they are at with things, and actively listen to them.
Inquire specifically. After 15-20 minutes or so of taking notes and really inquiring and listening to the RBT on a general level, begin the process of asking more incisive questions with specific programs. Like we talked about, you should have prepped before starting this consultation. You should know the programs that you want to address. You should have a general idea of what questions you want to ask. And, with having asked several broad questions already, chances are you have a little more information than you did when you started.
With that in mind, select a program, and start asking questions about that specific target or problem behavior. The goal here is to get your RBT to give you as much information about that specific target or problem behavior as they can. Keep them talking—but keep them on topic. Let them describe to you how they run the program, what usually happens, what their reactions are, and what the barriers are.
For example, let’s say your learner is matching identical pictures in an array of 8. You might ask the RBT if they’ve been giving the learner the sample first. The array first? how “spread out” is the array? Is the learner attending when they deliver the instruction?
Observe. Asking the above questions usually functions as a segue for you—the BCBA—to observe the actual program itself. If the RBT doesn’t offer to show you how they run the program, it’s at this point you’ll ask “How about we take a look? Would you mind showing it to me?”
Have the RBT run the program with the learner. Continue to ask questions along the way. Look for common errors in program delivery. Is the learner motivated? Is the learner attending to the instruction? Is the RBT giving the correct response away for “free”.
Important: Throughout the process of preparation, inquiry, and observation, you should be making quick notes to yourself. As you gather more information at each of these stages, you may change your course of action regarding that specific program. For example, the data may have originally indicated that the program was mastered. But, after observing the RBT, you see that they are subtly prompting the learner with a gesture prompt. This can change things.
Test. This is the part of the sequence where you’ll work with the RBT to figure out which strategies will be feasible going forward. This can take two forms. If you have enough rapport with the kiddo (and the RBT is fine with it), you can hop in and probe new targets (or possible adjustments to the existing target) with the learner yourself. Again, this approach works well if that rapport is there.
Or, if it makes more sense, you can prompt the RBT through probing new targets and adjustments with the learner. Either way, this phase is all about seeing how your learner will respond to these adjustments.
Decide. As you’ve tested through possible next steps for this particular target, you’ll want to think through and make a decision on what to do. At this point, it’s important to vocalize your thoughts with the RBT: “Okay, for this program, I’m thinking we need to increase the array size because...” This approach is impactful as it allows your RBT a window into your thought process. It lifts the curtain and removes the mystery behind clinical decision making. In doing so, it has the potential to make the RBT more adept at developing clinical insight themselves.
The other very important thing you’ll want to do is to ask them what they think about your conclusion: “Does that sound good? What do you think about that?”. It’s a friendly reminder that they have a say in it all and they’re expected to contribute.
Observe/Model. Once your RBT is cool with your next moves regarding this target, it’s time to hammer out the “how” of it all. That means having them sit down and actually run the program with the learner. Resort to good old fashioned BST in regard to this. Further, should you have the necessary rapport with the learner, hop in and model the process for the RBT to make it easier for them. The focus here is to ensure that the RBT understands your expectations in the way the program is carried out.
Record. This step gets overlooked…a lot! Whether it’s a shared document, an email, a Teams or GChat, or a specialized data collection center, make sure to record (somewhere) the changes and specific instructions for each of the programs. There should be a spot where members of the team can easily see the changes and follow up with ensuing questions or commentary. A digital area where an ongoing conversation can be had about each program is a major plus and increases clarity in regard to treatment adherence.
Repeat. Figure out which program is the next in line for adjustment. Follow this same protocol and work your way down with all of them. You’ll be surprised on how much more thorough and productive your consultations can become when you do!
I love strategizing on processes—especially consultations. It’s the one activity that we—as BCBAs—engage in the most. What are some of your favorite tips and trips regarding clinical consultation? Hit me back!
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Announcement: Looking for a (Better) Facebook Group to help with clinical decision making? My colleagues and I have launched a clinical support group HERE where the responses and feedback are curated to ensure you’re getting the best answers to your questions. Come join our community. It’s free! We want to make YOU better at your job.
Get pumped: Checkout bxmastery.com. Do you know BCBAs who are struggling with making quality decisions regarding program selection? We’ve got ABA goals in the thousands, with recommendations on where to start and where to go next. We’re still beta-testing this new tool and adding more skills and skill areas every day, but we’re excited because we think it will help a lot of people. Message if you’re interested in getting involved.