High Impact, Low Time: The Art of a Short and Sweet Consultation
Imagine that it’s a Friday.
It’s about 3:30 and thanks to near miraculous circumstances, a meeting has been cancelled which means that 45 minutes is put back into your day.
You decide to do a quick, 45 minute consultation with a client who you saw earlier in the week.
For most of us, 45 minutes isn’t nearly enough to put together a wholistic and impactful consultation. Each learner is complicated. Every program is even more complex (even though you wrote the program). And taking the time to ensure that everyone is on the same page (meaning the RBTs) is an additional nuance. One could argue that 45 minutes is practically useless for the purpose of consultation. But, as busy BCBAs, we simultaneously know that this time is precious.
So where do you start? What do you focus on?
Well, here are a few suggestions to ensure that even the shortest consultation yields productivity and progress with a learner.
Identify the programs that improve quality of life (QOL). No program is made the same. Some simply are more important than others. Yes, we want to see mastery in every single last one of them. However, there are certain programs that—should the learner become fluent in them—increase their quality of life either immediately or drastically (or both). Develop an instinct for recognizing these programs. For example, gaining independence in toileting can be far more important than identifying the key features of a buffalo. In a short consultation where both programs are indicating mastery, concentrate your energies on introducing the next steps of toileting. You can tackle buffaloes next week.
Pro tip: Make sure your staff know which five or six programs are most important. In sessions that are cut short, they can focus on these programs more.
Problem Programs. If there aren’t any programs that stand out in terms of increasing the learner’s QOL, there is usually a program or two that isn’t making progress the way we’d like it to. 45 minutes can be a perfect amount of time to concentrate your energies on that ONE program that isn’t progressing. Talk with the RBT about it and have them run the program repeatedly. Chances are you’ll find a discrepancy in how it is being taught OR you’ll notice a missing skill (or both).
Behavior Plan. For some of our learners, problem behavior plays a significant roll in deterring progress—especially early on. Behavior plans are tricky. They have multiple steps and are individualized to the learner. Additionally, behavioral topographies and functions can change from week to week. With all of this in mind, sitting down with an RBT and reviewing, discussing, and answering questions they might have is imperative. A short consultation is a perfect time to do this.
Pick an area and train. Finally, it’s not always the program or the behavior plan that needs tweaked. Training RBTs is a necessary and unavoidable component to working as a BCBA. Some RBTs are new to the field, new to the company, or simply new to having you as a BCBA. In many cases, if an RBT is struggling from the standpoint of programming, you’re likely well aware of it. Be specific with yourself about what it is that RBT is struggling with. Is it trial rates? Is it running a specific program? Is it recognizing and/or contriving motivation with the learner? Pick an area. A short consultation is an ideal time to spend observing and coaching an RBT in an area that they are struggling.
Traditionally, I advise clinicians to lean toward longer (2-4 hours) consultations than shorter ones that are broken up. Of course, this relies on the number of hours insurance approves and the preferences of the supervisor or organization, as well. Longer consultations allows a clinician to submerge themselves in the learner’s needs. However, I have a soft spot for these quick, shorter consultation opportunities (~45 minutes) too. I like to look at them as “focused consults”. Thanks to the limited amount of time, they actually force us to do something we can’t do in a longer consultation: to focus all of our energy on ONE aspect of the learner’s case. Think of it as a break from the longer more comprehensive sittings where we feel we have to do everything.
Reach out to me and share your thoughts and strategies!
Have a clinical question and want to nerd out about it? Join our exclusive Facebook Group!