Bonus Episode 35 - Compassionate Care Conference at UCP 2024

Summary

ABA Inside Track – Bonus Episode 35

Compassionate Care Conference at UCP 2024
Release Date: December 23, 2024

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Episode Overview

In this special bonus episode, the ABA Inside Track team shares their experiences attending the “Contemporary and Compassionate Approaches to Support Individuals with IDD” (Compassionate Care Conference) hosted by Upstate Caring Partners in Utica, NY. The episode features a sample of informal interviews with poster presenters, highlighting practitioner-driven research and applied behavior analysis (ABA) innovations focused on compassionate and values-driven care. The host and guests discuss practical hurdles, lessons learned, and new technologies for improving ABA outcomes, all in the lively atmosphere of a grassroots conference.

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Key Discussion Points & Insights

1. Conference Setting & Cultural Shift in ABA

• Host’s Purpose (00:13–02:57):
  • The conference brought together diverse professionals striving to advance compassionate care in the field of ABA.
  • ABA Inside Track hosted a panel on “creating cultural shifts in behavior analysis”, engaging both previous and new guests.
  • Informal poster interviews are used to showcase practitioner-driven research, including early-stage and boots-on-the-ground studies.
  • Notable attendees included Megan Miller, Natalie Williams Awadea, Mary Jane Weiss, Didu Raj Raman, Hillary Laney, and others.
  • The event fostered connections and highlighted progress in compassionate care practices across different regions.

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2. Poster Conversations – Practice & Innovation Highlights

A. Conditioning Faces and Voices for Communication

Victoria Beeman

• Topic (03:23–06:12): Using PFASBT (Practical Functional Assessment & Skill-Based Treatment) to condition learners to attend to human faces and voices, a precursor to more effective communication.
• Approach & Outcomes:
  • Two learners initially did not attend to faces/voices even during reinforcement.
  • Traditional pairing methods failed; PFASBT led to major gains in attention to faces and voices.
  • Key jump in “observing response probe” scores pre-/post-intervention (from 12/50 and 6/50 to 40/50 and 30/50).
  • Involving parents in data collection revealed carryover at home, increasing social validity.
• Notable Quote (05:45):
  “They were like, he’s looking at us... we’re talking to him and he’s responding... So much social validity.” — Victoria Beeman
• Practitioner Reflection: Lessons learned would change her current approach for more targeted face/voice conditioning.

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B. Shifting to Vocational Curriculum with EFL

Tara Hyatt

• Topic (06:15–09:07): Transitioning from academic to vocational skills using the Essential for Living (EFL) curriculum; observed impact on independence and well-being.
• Approach & Outcomes:
  • Switch emphasized life skills (stocking cafeteria, coffee carts, laundry, gardening, cooking), increased student engagement/happiness.
  • Essential Eight and Behavioral Health Index (BHI) scores showed improvement after shift.
  • IEP goals were restructured using EFL measures to increase real-world relevance.
• Notable Quote (08:51):
  “I was skeptical at first, but then once I saw how all my students really had deficits... it didn’t make sense to focus on those academic skills when they didn’t have basic skills they needed to be successful in life.” — Tara Hyatt

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C. Clinical Risk Assessment Tools for ABA

Meg Bro

• Topic (09:22–16:47): Development of a dynamic Google Form/Excel tool to objectively categorize client risk and streamline clinical decision-making for trauma-informed care and administrative oversight.
• Approach & Outcomes:
  • Tool automatically assigns clients to risk tiers (2B to 4D) based on behavioral severity, use of restrictive practices, staffing ratios, etc.
  • Integrates a three-tiered support model, requiring foundational plans, directorial review, deadlines for behavior reduction, and escalation procedures.
  • Increased support and collaboration between supervisors, enhancing “being a good boss” rather than blaming clinicians.
  • Positive feedback, though full adoption variable (“referenced in meetings”).
• Memorable Moments & Quotes:
  • (13:14): “I actually selfishly wanted this as a director... This gave us an opportunity to see, okay, what have you not been potentially. Okay, and where can I identify that you might need more support?”
  • (16:11): “We wanted it to be easy enough to access. It took about two minutes to fill out the Google forms.”

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D. Scaling Skill-Based Treatment (SBT) in Public School Classrooms

Melissa Walsh

• Topic (16:51–24:48): Implementing Skill-Based Treatment (SBT) for students with autism across 22 school districts, including gen ed and autism support settings.
• Approach & Outcomes:
  • Seven students across three districts, notably a kindergarten student who increased participation from 10% to nearly 80% and 99.3% reduction in problem behaviors.
  • Adaptation included dyads and creative leisure/EO manipulations (e.g., “Don’t Wake Daddy” game, “shopping” in school).
  • Collaboration with teachers; one gen ed teacher successfully ran SBT during classroom activities with provided prompts.
  • Social validity high; adaptation for student needs promoted (e.g., integrating peer support).
• Notable Quotes:
  • (17:43): “She is just amazing. I'd love to clone her. Her little guy actually was at about 10% participation at the beginning. We got him up to almost 80% and... 99.3% reduction within the Gen Ed classroom.” — Melissa Walsh
  • (21:06): “The adults are more impacted than the kids are.” — Melissa Walsh
• Lessons Learned: Creativity needed for HRE (Highly Preferred Reinforcers/Environments); encouragement of peer involvement; buy-in strongest when admin/teachers see impact; all students progress differently.

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E. Technology-Supported SBT at Scale

Hillary Laney (Centria)

• Topic (24:50–36:31): Using a custom-designed app (Care Connect) to standardize, scale, and oversee SBT (Skill-Based Treatment) interventions organization-wide.
• Approach & Outcomes:
  • App allows clinicians to graph and monitor session data, mastery progress, fidelity, and move through intervention steps as needed.
  • Supports decision-making, provides prompts, and allows for supervisor oversight without stifling practitioner artistry:
    • Users can override app recommendations; actions are logged for supervision.
    • App’s flexibility increases training efficiency and reliability, not rigidity.
    • Data shows mastering SBT steps typically does not require excessive trials.
  • Entire organization is trained in SBT paradigms, with foundation plans as Tier 1, SBT as Tier 2, and intensive consultation as Tier 3.
• Notable Quotes:
  • (30:25): “This is my child. His name is Apple. It's only available on iPads anyway. But... There's almost no decision that this makes that someone couldn't override.” — Hillary Laney
  • (31:34): “You cannot have this skill-based treatment process without artistry. The two are mutually exclusive.” — Hillary Laney
  • (35:25): “We don't want Tier 2 to be the kitchen sink. Because in the kitchen sink, people are making decisions that are not aligned with our values.” — Hillary Laney
• Scaling Reflection: Standardized, tech-supported processes help maintain values-based implementation and effectiveness across a large organization.

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Notable Quotes & Memorable Moments

• “So much social validity. They were like, he’s looking at us... we’re talking to him and he’s responding.” — Victoria Beeman (05:45)
• “It didn’t make sense to focus on those academic skills when they didn’t have basic skills they needed to be successful in life.” — Tara Hyatt (08:51)
• “The adults are more impacted than the kids are.” — Melissa Walsh (21:06)
• “This gave us an opportunity to see, okay, what have you not been potentially. Okay, and where can I identify that you might need more support?... Our goal was being a good boss.” — Meg Bro (13:14)
• “You cannot have this skill-based treatment process without artistry. The two are mutually exclusive.” — Hillary Laney (31:34)
• “We don't want Tier 2 to be the kitchen sink.” — Hillary Laney (35:25)

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Timestamps for Important Segments

• Conference overview and panel topic – 00:13–02:57
• Conditioning faces and voices (Victoria Beeman) – 02:57–06:12
• Shifting to EFL/vocational curriculum (Tara Hyatt) – 06:15–09:07
• Risk assessment/clinical decision tool (Meg Bro) – 09:22–16:47
• SBT in public school classrooms (Melissa Walsh) – 16:51–24:48
• Scaling SBT and the Care Connect app (Hillary Laney) – 24:50–36:31

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Takeaways

• Compassionate, values-driven shifts in ABA practice are tangible and occurring at scale, from individualized classroom adaptations to organization-wide technology solutions.
• Poster presenters provided real-world stories of iterative problem-solving, skepticism transformed by data, and the importance of social validity and flexibility.
• Standardization and technology do not eliminate practitioner artistry; instead, they can provide the scaffolding for consistency while nurturing clinical judgment and individualized care.
• The field is moving toward scalable, compassionate approaches that retain fidelity, empower practitioners, and improve client outcomes, as highlighted by diverse voices and innovative solutions at the Compassionate Care Conference.

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For listeners unable to attend the Compassionate Care Conference, this episode offers a dynamic portrait of the evolving landscape of ABA, with direct practitioner insights and examples of practical compassion in action.

Transcript

[Hillary Laney]

Foreign.

[Podcast Host]

Hey everybody. Welcome to a little bonus episode from ABA Inside Track. This summer we were fortunate to attend the Contemporary and Compassionate Approaches to Support Individuals with IDD Conference or the Compassionate Care Conference that was hosted by Upstate Caring Partners up in Utica, New York. We were really excited to get to go. We were invited by Dr. Eric Jacobson and his team to do some events with them. We did some ABA trivia the night before the conference started. And then we also were very fortunate to host a panel with some friends of the show as well as some new hopeful friends to the show on creating cultural shifts in behavior analysis. We got to listen to some great answers from Megan Miller, Natalie Williams Awadea, Mary Jane Weiss, Didu Raj Raman and Hillary Laney, who are our panel, our panel participants. We also got to say hi to a couple friends we hadn't seen in a while. We saw certainly Jess Slayton and both John and Joey Stauts. And Ron. I got the chance to meet someone I'd met on ZOOM a few times, Ron DeMucci, who also spoke about using SBT in schools and some of the benefits to using SBT at somewhat of scale. And then we just got to meet a lot of excellent new people who, who we, you know, you never know who you're going to meet at a conference. So some folks from Canada, some folks from down in Florida area, Louisiana area. It was a very exciting conference. We really thought it did a lot to progress a lot of the compassionate care work that most professionals in our field are really trying to improve so that we can continue to grow as a field and improve how we support our clients. So just a really, really great time. We were so, so happy to go. Hopefully everyone who got to meet us was not disappointed by the real thing. But what you're going to hear next are some of the posters. One of the things we like to do, we go to conferences is chat with folks who are doing posters because I think it's a great way to sort of get some good pre studies or smaller studies or some kind of boots on the ground work by practitioners as well as researchers as to what extensions we can do to many of the practices from our field. So we always love talking to folks. We didn't get to talk to everyone. There were a lot of cool posters we didn't quite get to in time. But here's kind of a sampling of some of the posters we were able to see while we were there. Again, we hope you enjoy hearing a little bit about the conference or from the conference and in 2026. When they host another one, maybe you'll get a chance to go as well. But in the meantime, please enjoy some of the posters from the. From the Compassionate Care Conference.

[Podcast Interviewer]

All right. I am here with Victoria Beeman at the Compassionate Care Conference. And Victoria, you were, you were explaining a little bit about your poster here, but I'd love to hear sort of what was it you were looking to do you some tab chaining. It's always one of those things that sounds easy when you describe it. And I always have a harder time explaining it from other people. So tell me about your poster and your. The work you were doing in there.

[Victoria Beeman]

Yeah. So I had two learners who were not conditioned to face their voices, meaning humans did not signal reinforcement. They were not attend to my face even during times of reinforcement or attend to my voice. So I had tried the traditional way of conditioning faces and voices through stimulus, stimulus pairing. I had been unsuccessful. So I was looking at PFASBT as a tool to kind of help rebuild that relationship. So I had two learners, both pre listeners, one pre speaker, one emerging speaker. And I was running the observing response probe, which is looking at in the environment. Will you attend to my. My face? Will you attend to my voice? And so when I originally started, I was looking at my learner's scores. They needed a 45 out of 50 to show me that we were reinforcing and we were getting 12 out of 50 and 6 out of 50. So we went through. I tried the traditional ways. It did not work. I also like to put this caveat in I know better now. I do better now. So my PFASBT would be way cooler now. But I did it. I worked a lot on academic cabs, which I wouldn't do necessarily now, but through it we see an increase in our learners attending to our face and voices in a non instructional setting with both of my technicians and only one of them was running SBT with them. So at the end of it, we were able to get condition reinforcement for voices with books. And we ended one of my learners at about 40 out of 50 and then about 30 out of 50. But if you look at the data, which y' all can't see, but there's a huge jump between selecting out faces and voices before I did PFASBT and then after. Yeah, that was really good. And they both really liked doing the cabs. We were empowering their language. We were building our relationship with them. One of my learners developed generalized matching generalized gross motor imitation under the correct contingency and One developed a coax.

[Podcast Interviewer]

So those are my favorite caps. The one where it's like I didn't really plan for this and then it magically happened. Ta da.

[Hillary Laney]

Yeah, ta da.

[Victoria Beeman]

And because now I would definitely target face and voice conditioning in the cat.

[Podcast Interviewer]

As a branch. Yeah, as a branch.

[Victoria Beeman]

But I did it at the end. But I also took data from the parents. So I had them take. We picked the most important ones for them for the observing response probe. And then I ran post caregiver scores and my scores and we saw some, some stuff kind of carry over.

[Podcast Interviewer]

That's nice getting.

[Victoria Beeman]

Yeah, I really. They really liked it. It was, it was. They were like he's looking at us. He wants. We're talking to him and he's responding. He's just looking at us. I thought I love that.

[Podcast Interviewer]

Oh right. That's. That's going to be so key for parents.

[Victoria Beeman]

So much social validity.

[Podcast Interviewer]

Excellent. I do appreciate too. I know it's hard to get in a poster. I do appreciate your lessons learned. Do it again. Would have done this because. Yeah. That it's hard to. It's hard to. To have your textual kind of cues with that. You don't have a lot of space. So thank you for sharing that as well.

[Victoria Beeman]

Thank you so much.

[Podcast Interviewer]

So I'm talking with Tara Hyatt and about her poster Adapting to change. I see you did a change from one curriculum to using EFL recently. We're fans of efl. We really excited to hear about it. So I'd love to kind of hear about your poster and sort of what you did.

[Tara Hyatt]

So we looked at how they're essential for living. The essential eight scores and the BHI scores, the behavioral health index, how those scores increased when we went from more academic to more vocational. The EFL skills. So when we made that change, we did more events in the classroom. So stocking and prepping the cafeteria in the morning, having a coffee cart, doing laundry, gardening. The kids go grocery shopping for meals that they want to prep and then they do cooking groups. And we had a lot of buy in from the staff because it made the day go by quicker. The students were active. The students enjoyed it. They loved going grocery shopping. They loved the cooking groups. And it was really interesting to look at how the essential eight, those skills of waiting, accepting, no. Making requests and tolerating health and safety, how all of those. We incorporated those skills into the events and we saw an increase in all of their averages and the BHI skills. So it's really interesting.

[Podcast Interviewer]

Yeah, I think that's one of those big questions when people kind of hear about EFL of like, when are they going to work on their IEP objectives? Which we wrote based on their, you know, the students hatred of traditional, you know, pioneer school curriculum that we are making everyone do. So it sounds like you had a good measure. Were there other ways that you were looking at? Sort of. You mentioned starting students seem to enjoy the activities. Was it more like just observable signs traditionally associate with happiness? Was it just measures from the EFL combination?

[Tara Hyatt]

It was measures of happiness as well as their IEP goals and their attainment of their objectives. So we used the EFL to help us see their skill deficits and write the IEP goals, and then we incorporated those goals into our EFL events.

[Podcast Interviewer]

Now, did you need get to convince powers that be about EFL or. It was sort of already a shift that was going on and so you just said, hey, let's see how it works.

[Tara Hyatt]

It was a shift that admin brought in and teachers adapted to it. I think once they saw the skills you could work on and the different activities you could do in the classroom that students enjoy, people were willing to make that shift.

[Podcast Interviewer]

Okay, good. Now where were you? Were you like, gung ho efl? Were you one of the skeptics who was like, I gotta do a poster to make sure this works before I'm really on board?

[Tara Hyatt]

I was skeptical at first, but then once I saw how all my students really had deficits in making requests or waiting or accepting.

[Victoria Beeman]

No.

[Tara Hyatt]

That it didn't make sense to focus on those academic skills when they didn't have basic skills they needed to be successful in life.

[Podcast Interviewer]

Okay, well, thank you so much. It's so exciting to see the implementations in a classroom setting. And thank you for admitting that you were a little skeptical of it too. It does a little bit. Little more validity to the results, I think. Thank you.

[Melissa Walsh]

Thank you.

[Podcast Interviewer]

So I'm here, I'm talking with Meg Bro about risk categorization and clinical decision making tool. I'm a huge fan of any tool where I can do like a flow chart or I can just sort of see the steps, especially when it's about. Okay, am I doing trauma informed care? Because it's something that, you know, I didn't learn in grad school. I've sort of had to learn on the go.

[Melissa Walsh]

Yeah.

[Podcast Interviewer]

So I'm very excited to hear a little bit more about this work.

[Meg Bro]

Yeah. So I am an Excel nerd to.

[Melissa Walsh]

The core, so I love the data.

[Podcast Interviewer]

Is there a pivot table involved in this?

[Meg Bro]

There's not, but we have them. So this was a Google form that we created. It was a questionnaire that was dynamic. So it asked supervising clinicians questions based on categorizing the client's most dangerous behavior they engaged in. And so after answering a few questions, it would categorize them as a level two, two, a level three, which was moderate risk, or a level four, which was high risk. And then from there additional questions were broken down. And so those additional questions asked about like frequency of the behavior, if there are restrictive practices in place. So are they still having restraints, are they potentially having seclusion? A one to two staffing ratio, incident reports, those are all things that would categorize them higher on a risk level. So after the supervising clinician completed the questionnaire, it would categorize them from 2B to a 4D. And so a 4D is reflective of a client that needs more attention and suggesting that that BCBA most likely needs more clinical support from a higher trained BCBA who knows pfa, svt, universal protocols, et cetera. So here we kind of have, after you complete the questionnaire, the BCBA got the responses, so did their supervisor. So director of clinical services. And then we had a large Excel. This is where the pivot comes in that area. Director Clinical services could sort to be able to see, okay, out of my entire market, what clients am I responsible for doing overlaps with what clients do I need to look in and do some more integrity data for?

[Podcast Interviewer]

Okay.

[Meg Bro]

Additionally, based on risk level, they were given a three tier decision making model. And so this is where the kind of thought was that if you have a client who isn't decreasing problem behavior, most likely they're not getting services that.

[Melissa Walsh]

Are aligned with what we want.

[Podcast Interviewer]

Sure.

[Meg Bro]

And so initially tier one was making sure that they had a foundational plan that was in place. That is kind of our universal protocol built into a behavior plan. It's really antecedent heavy. It identifies signs of ascent, signs of ascent, withdrawal. So that was step one. Do you have a foundational plan in place? Directors of clinical services had to review the foundational plan and then based on risk level. So if I had a 2D client, I was responsible for also doing an overlap with that BCBA to make sure that the foundational plan was being run with integrity. We had deadlines assigned for when that behavior should be reducing based on risk level. So if you have a level two client, it's not probably the highest priority. If you have a level four client, that's your fire.

[Podcast Interviewer]

Yeah, yeah.

[Meg Bro]

And so like Put all your attention that behavior should be decreased in three to four weeks. Otherwise, you should be moving to Tier 2, which is starting to look at SBT, doing a PFA for the client. Similarly, we had competencies as well as additional oversight that needed to be provided based on risk level. And then if that behavior reduction goal wasn't met, you'd move to additional complex case consultants.

[Podcast Interviewer]

Gotcha. Okay, now, was this. Were you mostly seeing this as a means of. Of safety for the client? Was there a part of you that was thinking like, oh, there's going to be organizations that want this to talk about funding, or that didn't come out?

[Meg Bro]

I actually selfishly wanted this as a director. I think a lot of times I'll have BCBAs that I'll say, what clients do we need to talk about? And they're maybe really heavy focused on this challenging parent, or they're heavy focused on my technicians are implementing. And so this gave us an opportunity to see, okay, what have you not been potentially. Okay, and where can I identify that you might need more support? So if we had a bcba, I'm in Massachusetts. We're a smaller market. Our Michigan market, our Arizona market, rather large. What you might see more. So is one BCBA who had multiple three or for clients. And that would kind of suggest. Are you. Are your people trained well in your foundational plan? Do I need to be overlapping with you more, supporting you more? And so that was really our goal, was being a good boss.

[Podcast Interviewer]

You wanted to be a good, helpful boss, not just tell people do better or like, you're not making it work. You.

[Hillary Laney]

Actually.

[Podcast Interviewer]

Let's look at. Let's look at what the variables of relevance are. Okay, I like that.

[Meg Bro]

How do we allocate our support based on something that has been predetermined and categorized instead of more of a subjective measure of. Okay, this is who I want you to see this week. And it's, you know, their best client because they want to show off. So that was kind of our. Our goal. We've got some social validity data. This was from the director level. So he saw overall, I would say, positive results. So you're seeing like an average of scoring four or five, which is good. I would say anecdotally, I think people didn't use the action tool, Excel spreadsheet, as much as I would have loved, but they did reference it in their meeting. So I'll take that.

[Podcast Interviewer]

Is this. So it's still going on. Are you making iterations on the overall plan for the future?

[Meg Bro]

Yeah, I think we're kind of learning as we go and getting feedback. My Excel spreadsheet was a little intense.

[Podcast Interviewer]

Does it color code? I didn't ask you, Meg. Does it auto color code so people could see, oh, I better talk to the boss about this.

[Meg Bro]

It had updated deadlines that were automatic. And I think that through a loop a little bit. But yeah, I've been working with Hillary a lot. Hillary Laney, on kind of identifying what are the bigger picture steps that we would want people doing at each of these tiers so that you don't have. Okay. In this market you have this director of clinical services supporting in this way, and then you work in another market and you have a total different experience. So kind of like a guideline to align people in, in how to support cases.

[Podcast Interviewer]

Very cool. I love, I love anything that is like, adds a level of systemization but is meant to be supportive of everybody involved, the clinicians, the clients. I think that is always such a needed system. And this doesn't seem like it over compartmentalized everything either, which I'm assuming it was a goal of. Like this can't be too rigid as to.

[Meg Bro]

We wanted it to be easy enough to access. It took about two minutes to fill out the Google forms.

[Podcast Interviewer]

That's great.

[Hillary Laney]

Yeah.

[Meg Bro]

And you got an automated email response. So hope for a low, low response effort for supervising clinicians.

[Podcast Interviewer]

Very cool. Thank you so much.

[Hillary Laney]

Thank you for sharing.

[Meg Bro]

Thanks.

[Podcast Interviewer]

All right, so I'm talking with, with Melissa Walsh about skill based treatment in public school classrooms. So I'm guessing your findings were. Nobody wanted, nobody had time. There weren't enough resources. And you found nothing is right. There's a lot of poster here, so I'm guessing that's not the case.

[Melissa Walsh]

We found some amazing results, actually.

[Podcast Interviewer]

Good.

[Melissa Walsh]

So I covered 22 school districts. We had three school districts that allowed us to to video and use their data for my dissertation. So it was really exciting.

[Podcast Interviewer]

Even better to get a dissertation. So you needed data at the end of it.

[Melissa Walsh]

I needed data. So we have seven students. Most of them are in autistic support classrooms. One of them was in a kindergarten classroom. And we actually had a kindergarten teacher running SBT while she was doing classroom read aloud and center times.

[Podcast Interviewer]

Wow.

[Melissa Walsh]

Yeah, it's amazing.

[Podcast Interviewer]

Unicorn teacher.

[Melissa Walsh]

Yes. She is just amazing. I'd love to clone her. Her little guy actually was at about 10% participation at the beginning. We got him up to almost 80% and we had almost a 100% reduction in problem behavior. We were at like 99.3% reduction within the Gen Ed classroom.

[Hillary Laney]

All right.

[Podcast Interviewer]

Wow.

[Melissa Walsh]

So it was really exciting. He was our most exciting. We also had an autistic support classroom where we were running SBT and a dyad.

[Podcast Interviewer]

Okay.

[Melissa Walsh]

Because all of our ratios are at least 4 to 8. And then obviously the kindergarten one was 2 to 22. So we had to get creative. And we had two students who were in hre, like parallel play. And then we had a para or a teacher placing the EO and running trials and. And taking data at the same time.

[Podcast Interviewer]

Were the students in the dyad, you know, from the isca, had kind of the evognitive situations been similar? Were they different enough that you sort of had to get creative with what it looked like or what was that?

[Melissa Walsh]

They were actually pretty similar. So they both enjoyed pretend creative play, but on their own. That was HRE on the floor. And then the EOs were coming to the table to do work. And then we also did a leisure EO where we had them playing a game together. So it was flexible gameplay.

[Podcast Interviewer]

Okay.

[Melissa Walsh]

And then they had to take turns with each other. And we were doing games like don't don't wake Daddy threatening don't wake Daddy game. They loved it. But the problem was they wanted all the turns, you know?

[Podcast Interviewer]

Okay.

[Melissa Walsh]

So it was waiting. And then we slowly elongated the amount of turns that you should.

[Podcast Interviewer]

So those were one of the. One of the kind of the chains that you'd identified.

[Melissa Walsh]

Yeah, that was one of our branches is with the leisure skills.

[Podcast Interviewer]

Okay.

[Melissa Walsh]

Let'S see. What else would you like to know?

[Podcast Interviewer]

I mean, I guess in terms of. I mean, did you find your procedures were very similar for the kindergarten classroom versus in the autistic support classrooms? Because I know one of the. I don't. I don't want to call it a limitation of pfasvt, but definitely a hurdle is what does this look like when I'm not in a classroom that is sort of set up to do this level of individualized programming? So did you have to do a lot of kind of tap dancing to make it work for that kindergarten teacher, the teacher, or was she just that amazing that it felt the same across settings?

[Melissa Walsh]

So we started out having the special ed teacher in their modeling. We were using Zoom, and I was talking to the special ed teacher through Bluetooth.

[Podcast Interviewer]

Oh, always fun.

[Melissa Walsh]

It was amazing. And so she modeled. The Gen Ed teacher was watching while she was running centers. When she felt comfortable, we kept asking, do you want to try? We would give her little note cards as to what to say, you know, little prompts. To help her out. And it went really well. She had a couple of mishaps where she was like, oh, my gosh, I totally messed that up. But it didn't matter.

[Podcast Interviewer]

You know, it's a leak. It's a little bit of a looseness to. To the SBT work sometimes, Right? That's okay.

[Melissa Walsh]

One of the main things that people were worried about was what's going to happen with the other kids in the classroom and what we've found. And I found this in other classrooms, too. The adults are more impacted than the kids are.

[Podcast Interviewer]

Oh, it's so true. It feels like such a straw man argument at this point of, like, the other kids will learn to do all the same. I've never seen it happen.

[Melissa Walsh]

Totally did not happen.

[Podcast Interviewer]

It's an exception to cruise rule. I've seen everyone's twice, but rare.

[Melissa Walsh]

So read aloud time. All the kids on the floor, my guys rolling around on the carpet, she would pause and say, all right, buddy, it's time to sit up and join the class. And they would run through the EO and it worked out perfectly. We didn't have any other students engaging in that behavior. We just explained to them what was happening. We had a couple little moms who would come over and they would actually start trying to run traffic trials with him. They were picking up on the language, and he was actually more likely to go with them and work with them in centers than the adults.

[Podcast Interviewer]

Well, that was. I mean, were you expecting that? I mean, about social validity of, like, I'm seeing this and I like it, I'm going to be a part of it. Even though no one has trained me.

[Melissa Walsh]

In this procedure, we actually first tried to run it in the special ed classroom. We could not get this guy to HRE in the special ed classroom. He needed to be in gen Ed. So that's how we started.

[Podcast Interviewer]

Oh, wow.

[Melissa Walsh]

Running it in gen ed because he wanted particular friends with him. So that's. That was really.

[Podcast Interviewer]

I. I find that often is kind of a good precursor. But if you like the social reinforcement, then you're going to like a lot of what we're about to, you know, present to you. You're going to see a lot of those ascent actions from the student.

[Melissa Walsh]

Yes.

[Podcast Interviewer]

Oh. So was anything of looking forward, anything that you learned from this process that. Okay, this is. I'm doing SBT differently now because of the lessons I learned from this process.

[Melissa Walsh]

We learned so much. I think each student taught us something different. I learned to get really creative with hre, one of our guys. HRE was in the hallway. We learned that for some guys, it's in the gen ed classroom. Everyone was different. We really changed the omnibus man for a lot. We had a lot of very vocal students who would say, not right now. I need more time, please.

[Podcast Interviewer]

So you shaped. You were able to shape it a little bit quicker into the more specific, you know, mand.

[Melissa Walsh]

Absolutely. They went very quickly through the first three levels, and then we slowed down a little bit once we got to relinquishing and transition. But we made it, and we learned to be very creative because of the lack of staff, the lack of space. We had one kiddo we could not get to hre so we had him go shopping through classrooms.

[Podcast Interviewer]

Oh, okay.

[Melissa Walsh]

So he would get to go on a walk throughout the school with a favorite staff member, and anything that he was interested in, we would either borrow or we would try to find something similar to take back to the classroom.

[Podcast Interviewer]

I'm curious, what was the procedure you used to get the school administration and all the teachers who may or may not know, who is this person? Who is this adult? To get everyone on board? Or was it one of those things that just happened rarely enough that everyone is too shocked to respond negatively?

[Melissa Walsh]

The classrooms that we went into were people that we knew it would be okay, and we had prefaced it with them. Admin. Because this student had such severe problem behavior, they were bought in from the beginning.

[Podcast Interviewer]

Whatever you can do, just go for it. Okay.

[Melissa Walsh]

We did not have a problem with admin at all. They were like, what do you mean?

[Podcast Interviewer]

That's.

[Melissa Walsh]

We will help you. Yes. So, yeah, we really didn't have problems with admin at all.

[Podcast Interviewer]

Excellent.

[Melissa Walsh]

And as the teachers are seeing it work with students, we're seeing the snowball effect.

[Podcast Interviewer]

All right.

[Melissa Walsh]

So we're getting more and more teachers interested and asking about it, which is really cool, where we want to be.

[Podcast Interviewer]

Well, Melissa, thank you so much for sharing. Really appreciate it.

[Melissa Walsh]

You're welcome.

[Podcast Interviewer]

I'm here talking with Hillary, who I just did an amazing panel.

[Melissa Walsh]

Thanks.

[Podcast Interviewer]

I didn't do. I was around for the panel. The panel itself was amazing. Thanks to you and your panelists. It was so good. But you presenting on SBT and social. Social and scaling.

[Hillary Laney]

Yeah.

[Podcast Interviewer]

Which is an issue that I don't want to say I have an issue with SPT around scaling, but I do find it to be something that is a big question.

[Hillary Laney]

How do you scale it? Yeah.

[Podcast Interviewer]

So you're gonna have all the answers, I'm sure.

[Hillary Laney]

Not on this poster. I have an app. I have a presentation tomorrow Talking about how to scale ascent based care.

[Podcast Interviewer]

Okay.

[Hillary Laney]

Skill based treatment is our tier 2.

[Podcast Interviewer]

Which time are you doing that? I'm gonna.

[Hillary Laney]

Second session.

[Podcast Interviewer]

Second. Okay. I think I'm gonna. We're not sure our departure time, but I know I saw it on there. I was like, I'm gonna make it for that one.

[Hillary Laney]

Skill based treatment is our tier two intervention. It is not our tier one intervention, which is why it's more scalable.

[Podcast Interviewer]

Okay.

[Hillary Laney]

Our tier one intervention is actually our poster next to me, which is our foundational plan.

[Podcast Interviewer]

Okay.

[Hillary Laney]

But at. At Centria, we've done over 500 practical functional assessments. And that's that poster. And this is the skill based treatment efficacy of our tier two intervention. So what we have is our own data collection app called Care Connect. And when I. It's not available for public purchase, but when I started at Centria, they asked me to build skill based treatment on it because they knew we wanted to scale the practice. And without data validation visibility, you can't scale.

[Podcast Interviewer]

Yeah.

[Hillary Laney]

So this is our app for sbt. And what it does is it gives. It does a lot of things, but it gives clinicians really specific visibility into the learning opportunities for sbt.

[Podcast Interviewer]

Oh, my, yes.

[Hillary Laney]

It graphs their data for every session based on the highest level of SBT run and the number. It'll tell you the number of trials your tech run. What this has allowed us to do is to look at our data in whole. And so what these figures are is all of our clients who run sbt, how are they doing on mastery? Because part of scaling is ensuring fidelity, effectiveness, and accountability. So what we did is this dotted line tells us our gold standard of how many learning opportunities it should take to master each level. So for FCR and TR, we say 30, Cab 1 and Cab 2 we say 40, and Cab 3 to 6, we say 40. Meaning you should master your Cap. 3 and 30. 40 learning opportunities on this graph. This bar graph represents the number of clients who are running this step during this time period. And this dot represents how many learning opportunities it took them. So for FCR and TR, we're averaging around 10 learning opportunities to master FCR. 10 for TR. For CAB 2, we're around 35 learning opportunities, and for CAB 3 through 6, we're around 40. So what this allows. This is like allowing us to see that we're doing this with efficacy and it's not taking forever. Like, what we don't want is clients sitting in intervention for hundreds of days.

[Podcast Interviewer]

Oh, and it's so. It is so easy to do.

[Hillary Laney]

It's so easy to get stuck. And so what. One of the things that helps us. There's a couple things that helps us do this One is obviously training technology can help us too. So this application makes some decisions for people around what to do. So it'll tell you if you've mastered it, and it'll move you on. It'll tell you if you should go back. It'll tell you if you should slow down because you're having too many interfering behaviors. It'll tell you to go. To synthesize reinforcement. So the application helps people make decisions that increase the efficacy of the intervention.

[Podcast Interviewer]

Okay, so, Hillary, I have to say a. I love the app. Will it remind me the difference between the CAB branches? Because I tend to start smooshing them together once I get beyond, like, 3, 3, and 4. The kind of this.

[Hillary Laney]

They're clear the same, right? So it won't tell you that, but what it does is it'll. Right here. It'll tell you what you're doing.

[Podcast Interviewer]

Okay.

[Hillary Laney]

So it's like, okay, run a cap five. And you're like, what does that mean? Well, it'll say four minutes of.

[Podcast Interviewer]

That explicit. For the.

[Hillary Laney]

And then you would have your programs. You want your technician to take data on here as well. So you would take data on their toleration and their skill acquisition.

[Podcast Interviewer]

Now, that sounds like a huge, huge relief for a sec. I've worked with some fabulous people. Like, they get the art that kind of comes into doing SBT, but it is. Here's the 50 programs I need you to juggle. Here are the chains I need you to juggle. Here's the data system I need you to do. It's kind of a mess. Do your best with it and try. You know, you. You see progress, but you're never sure if it's the progress you think it should be, because they're just doing the best they can do. So something like this does take a lot of that guesswork out of. And you can see.

[Hillary Laney]

You can see. See if they're making progress. You also, like, you might run more than one branch. You can switch branches on this. You can say, okay, I'm running my branch.

[Podcast Interviewer]

A. No, I'm running my.

[Hillary Laney]

We have the branches named. So, like, this is a structured learning branch. It tells them how many learning opportunities they've run, how many were. Right.

[Podcast Interviewer]

Yeah.

[Hillary Laney]

What they're supposed to be doing. This shows them where they should. Like, this is saying, you're running. You're going to run a cab 5. But you're like, what does that mean? Well, you don't really have to worry about it because it'll tell you what to do here.

[Podcast Interviewer]

I could use that. I honestly, I start losing track of where my. My caps are up. I don't have my plan in front of me.

[Hillary Laney]

So technology can support our efficacy and efficiency in our process.

[Podcast Interviewer]

That's such a great use of it. Now, is there any fear that the staff will lose some of the flexibility, the artistry, because it becomes too prescriptive, and then we run into the same problems you ran into with like, DTT is amazing. However, when all you do is teach steps. Here are the steps and go. They fail. Well, they. They don't fail. It's a failing of the training to remind them. It doesn't always have to look this way. You can add this. Or is it sort of one of those problems of like, let's worry about that a little later, because we just need to scale this.

[Hillary Laney]

No, no, it's not a problem to worry about later. It's a problem to think about now. I built this myself. This application I designed.

[Podcast Interviewer]

Did you get the.

[Hillary Laney]

Designing the whole thing?

[Podcast Interviewer]

No way.

[Hillary Laney]

Yeah. This is my child.

[Podcast Interviewer]

Oh, my goodness.

[Hillary Laney]

His name is Apple. It's only available on iPads anyway. But no. So to some extent, maybe that's true. However, this. There's almost no decision that this makes that someone couldn't override.

[Podcast Interviewer]

Okay.

[Hillary Laney]

Also, there's levels of ability in here to allow people to make decisions. So, for example, in this example on the screen, it's prescribing what trial to run. But let's say I've taught you how to do SBT and you have some artistry. I can let you select what you want to do. So I can build that in. Right. Like, there's. I can build in within and across choice making for anyone running this. But in the beginning, I don't necessarily want that for someone who doesn't have the artistry, but I need to teach it to them, and I need the technology to allow them to make those decisions. And it does. Okay, so, like, for example, this will tell you you've been in synthesized reinforcement too long. Run a trial. Well, they can say no. They can say, not right now. Or it'll say, hey, X, Y, and Z happened. Do this. And they can say, no, I want to make a different decision decision. It will allow them to do that. And what it also does is it graphs the decision they made. So as a supervisor, I can see, oh, they decided to do X. Oh, they decided to do Y. And so then I can kind of check your decision making even if I'm not there.

[Podcast Interviewer]

Okay.

[Hillary Laney]

So it still allows for artistry. Art. You cannot have this skill based treatment process without artistry.

[Podcast Interviewer]

Yeah.

[Hillary Laney]

The two are mutually exclusive.

[Podcast Interviewer]

It is so very. It is so very true. I do see you have social validity scores. They seem pretty good. So everyone seemed happy. I mean, I would be surprised because I think most RBT is when you're. I mean, I don't know if you have this experience when you're describing sbt, it's like they get the concept, but the idea of doing it, it's like, I've never done anything like this in my life and I'm scared I'm going to fail and the kid's going to get upset and everyone's going to be mad at me.

[Hillary Laney]

Yeah, well, we maybe had that problem when we first started doing this process, but our entire organization has shifted towards this. So every supervisor is trained in this way. Every technician, DCS is everybody at this organization. So while maybe our technicians don't know how to do skill based treatment, the tenets behind it, reinforcing severe problem behavior, focusing on ascent hre, ensuring baseline. All of that lives in our every service, which you can see in our next three posters. Like, we have our Tier one intervention is our foundational plan, which is not spt, but it takes the beliefs behind it and puts them into place. Then we also have our technician training training, which embeds all of that. So it really shouldn't be scary for our techs because it shouldn't be new. And I think that's what makes SBT scary is it's like all of a sudden we're changing everything and everything's new. That's not true for us. So it's a different challenge. When it was new, sure. That was a hard thing.

[Podcast Interviewer]

Yeah. Now I'm curious, how did SBT fall into the tier two bucket? Because I've always seen, at least in like, you know, the public schools I've worked in as SBT requires such a high level of individualization that it just invariably is a Tier 3 system. Maybe at best, it's a Tier 3 system run in a general education setting. But that's like the best you're going to do. Why is it categorized as Tier 2 in. In this. In this work?

[Hillary Laney]

So our Tier 1 is our foundational plan, which is like how we want all clients to be treated with dignity and respect at all times. What I'm going to talk about in my talk tomorrow, and I kind of talked about in the panel is like, we need to know what our desired outcomes are. Right. It's like, to understand when to move our tiers, we need to know our goals. So if we're not meeting achieving our goals with our foundational plan, we don't see any other step that we want our clinicians to take. Because while it is intensive, it is scalable and repeatable in a way that most other behavior intervention plans are not. And so that makes it a more accessible tool for us. We can replicate it, we can send, we can set standards around it, we can track those standards, and we can make sure people are being held accountable to our expectations, which is not necessarily true with DROs, DRAs, DRIs token economies, punishment extinction, because they don't have this level of standardization around them. So that's what makes it our tier 2. Our tier 3 is then clients who are not making our meeting our desired outcomes looks like PFA and svt. They get complex case consultation, which is where we start to put more resources in place. Okay, all of our supervising clinicians and techs are trained in this, but maybe their client has some idiosyncratic needs. That's our tier three is. Now I have to come in and teach you about idiosyncratic attention and escape conditions. Maybe we have to do a more formal FA. We actually see a formal prescriptive FA as a Tier 3 intervention because it's not as scalable, it's not as replicated, and it takes a lot more skill to pull it off.

[Podcast Interviewer]

Yeah, very true. I mean, I definitely agree. Like, the, the, the ISCA itself I've always seen is like, to some extent, I'm almost like, this is kind of a tier one intervention because I'm just sort of watching these things. Yeah, parsimony. Right?

[Hillary Laney]

But maybe not.

[Podcast Interviewer]

Yeah, no, no, no. That definitely moves into that other category. But I appreciate you, you're going through that process, because I think MTSS is one of those. One of those kind of procedures that everyone kind of gets to tier one. They kind of get tier three, and then tier two is, I guess, anything that I wasn't told about.

[Hillary Laney]

It's the kitchen sink. We don't want Tier 2 to be the kitchen sink.

[Podcast Interviewer]

No.

[Hillary Laney]

Because in the kitchen sink, people are making decisions that are not aligned with our values. And so this is what makes it scalable, because we know these procedures are backfire values. We know what they're supposed to look like. So I can go in anywhere and say, that looks good, that needs support, that's meeting our standards, that is not. You don't have that with other things.

[Podcast Interviewer]

Very true.

[Hillary Laney]

Intervention.

[Podcast Interviewer]

Oh, well, Hillary, thank you so much. I really appreciate you sharing. And I know we're running low on time, so thanks for sharing a little about some of the other posters.

[Hillary Laney]

I might not get eight posters.

[Podcast Interviewer]

Oh, wow.

[Hillary Laney]

Yeah, we had this skill based treatment. We did our 500 PFAs. We have our foundational plan poster right here that goes through our tier one intervention. We have coordination of care poster around working with outside providers. New we have our training poster for our supervising clinicians, our training poster for our behavior technician.

[Podcast Interviewer]

Wow.

[Hillary Laney]

And we have our tier 3 intervention over there which is complex case consult. So it's essentially our whole model.

[Podcast Interviewer]

So you guys are going to take a nice long weekend after all this work, it sounds like.

[Hillary Laney]

And all of it. I'm going to talk about basically every poster tomorrow during my.

[Podcast Interviewer]

So I should record the talk is what you're saying. You should. Well, Hillary, thank you so much. So great.

[Hillary Laney]

Thanks for letting me be on the panel.

[Podcast Interviewer]

Oh, yeah.

[Hillary Laney]

SA.