This is a transcript from our podcast episode published February 2020. The podcast episode is offered for .1 ASHA CEU (introductory level, professional area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.
[00:00:00] Kate Grandbois: welcome to SLP.
[00:00:14] Amy Wonkka: Narrowcast I'm Kate and I'm Amy, and we appreciate you tuning in and our podcast. We will review and provide commentary on resources, literature, and discussed issues related to the field of speech-language language. You can use this
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[00:01:12] Amy Wonkka: just a quick disclaimer. The contents of this episode are not meant to replace clinical or. SLP nerd cast its host and its guests do not represent or endorse specific products or procedures mentioned during our episodes, unless otherwise stated we are not PhDs, but we do research our material.
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[00:01:46] Kate Grandbois: Before we get started in today's episodes, financial and nonfinancial disclosures. I am the owner and founder of grand watt therapy and consulting LLC. And co-founder of SLP nerd cast. Amy Wonka is an employee of a public school system and cofounder of [00:02:00] SLP nerd cast. Uh, we're both members of Ashesi 12 and both serve on the AAC advisory group from Massachusetts advocates.
I am a member of the Berkshire association for behavior analysis and therapy, mass ABA, the association for behavior analysis international and the corresponding speech, language pathology and applied behavior analysis, special interest group. Welcome to our first episode of SLP nerd cast. I'm Kate Grandbois I'm Amy Wonka.
And today we are talking about collaboration with BCBS. Amy, why did we choose this topic?
[00:02:34] Amy Wonkka: Uh, because you are a BCB. It's true. It's true because we personally learned a lot through collaborating with
[00:02:42] Kate Grandbois: BCBAs. It's true because almost every SLP is going to end up working with the BCPA at some point in their careers.
Fair
[00:02:53] Amy Wonkka: points. Also sometimes they make us
[00:02:57] Kate Grandbois: gravitate. That's that's the, it's the [00:03:00] unspoken truth. Yeah. That sometimes SLPs and BCPS do not see eye to
[00:03:05] Amy Wonkka: eye. Yeah. It's hard to get along.
[00:03:08] Kate Grandbois: It is. It is. But we are going to try and explore that a little bit today. Um, the content of our episode is going to be some background information about collaboration, uh, background information about ABA.
And then finally some, uh, I guess you could call them tips and tricks for how to collaborate. Effectively with, we won't say the enemy. We will say the front of me or the other colleague and collaborator, the friend
[00:03:36] Amy Wonkka: we haven't met yet.
[00:03:37] Kate Grandbois: Yes. The friend, the BCBA friend that we haven't met yet. I love that.
Okay. So. I guess moving on Amy, why don't you tell us a little bit about why collaboration is so
[00:03:48] Amy Wonkka: important? Well, I mean, I think we all know that collaboration is important and regardless of where you work as a speech language pathologist, you need to work with other people. Um, if that's in the medical setting, you're working with a bunch of [00:04:00] allied health professionals.
If you're in the public schools, you're working with teachers and other therapists. If you're outpatient, you're working with a bunch of different professionals as well. So it's an important part of the job. Um, being able to work effectively with other people can be easy and wonderful. It can also be challenging and frustrating.
[00:04:20] Kate Grandbois: That's true. Yeah. I think every single clinical professional out there has had at least one argument disagreement, professional disagreement, probably especially with this.
[00:04:33] Amy Wonkka: I think that that's fair to say. It's a fair point when it's easy. It's clear that working together is the best option. Right? We learn about the other person's discipline.
We learn about how it affects our work with our clients, how we can carry over their goals, how they might be able to carry over our goals. Shoot co treatment shoot, shoot shocks. I'm trying really hard.
no, this is good. Clean, fun, nerdy, [00:05:00] clean
[00:05:01] Kate Grandbois: SLP fun. That's right. Coach rates.
[00:05:05] Amy Wonkka: As you were saying, grain brainiac. Yes. Continue. Coach rates are great. You know, I have had some of my, um, some really great clinical experiences working. Collaboratively in the same session with an occupational therapist or a physical therapist, I feel like I've learned a lot.
Um, we've been able to maximize, you know, the positioning and location of the, of the client in space that helps with communication. Also, their activities can be more fun than not. Oh, teas have all the fun. They have a lot of PTs have lots of
[00:05:37] Kate Grandbois: every single client I've ever shared. They hate coming to speech and they love going to OT.
We maybe picked around any OTs out there. We have jealous feelings about your swings and your putty. I do love it.
[00:05:50] Amy Wonkka: I do too. Um, so that's our love Fest for other therapists, but how about when it's bad? Right. When it doesn't work, which happens, it does [00:06:00] happen. Uh, and that's, that's not something that's unique to BCBAs.
No, that can happen in general, but when. Doesn't just naturally happen and it's not magic and a love Fest. Um, I think it's helpful to remember that our code of ethics has a lot of components in there that talk about the necessity of collaboration. So if you read principle one section B of the Asher code of ethics, you'll see, it says individuals shall use every resource, including referral and or interprofessional collaboration when appropriate to ensure that quality services provided.
So. Principle one, that's the part that talks about holding paramount, the welfare of the people that we serve professionally. Um, you know, sometimes we want to pack up our toys. We want to leave the sandbox and save man. Uh, but that really isn't in the best interest of our clients, patients, students, whatever word you use.
Well, I
[00:06:50] Kate Grandbois: think especially when you consider the majority of people that we see. Well, maybe not the majority, but a high percentage of people that we serve are also seeing other professionals, [00:07:00] um, you know, thinking about complex learners, individuals with autism individuals, with complex bodies, they almost always have a team of people.
At least in my clinical experience, there are very few clients I've seen who just have one. Communication issue. So
[00:07:17] Amy Wonkka: I feel like what you're saying is that as speech pathologists, we should figure out how to collaborate with other people.
[00:07:22] Kate Grandbois: Yes. And I think based on our code of ethics, we
[00:07:24] Amy Wonkka: sort of have to, that is what it seems like there's a whole nother principle principle, four that's about upholding the dignity and autonomy of the profession.
Maintaining. Collaborative and harmonious inter and intra professional relationships and accepting the self-imposed standards in our fields. So that's also another really long sentence.
[00:07:43] Kate Grandbois: The difference between inter and intra professional. I'm so glad
[00:07:46] Amy Wonkka: you asked. So interprofessional talks about within your own profession.
So among other speech pathologists in try. Uh, with across other professions. Okay.
[00:07:58] Kate Grandbois: Okay. Probably have known that, [00:08:00] but I didn't know. It's a good question. I don't know everything, but I'm
[00:08:02] Amy Wonkka: collaborating with you to learn. Look at us collaborating together, and we actually are inter ending. I guess, because not only are you a speech pathologist, you're a, and that is also true.
Wow. Fancy stuff. Um, I mean, really, I think you can make the case for collaboration weaving its way through a lot of other areas of our code of ethics as well. So, you know, if we look at principle two, that's looking at the need to achieve and maintain the highest level of professional competence and performance.
So if your job puts you in a situation where collaboration with ABA providers is part of the deal, some professional development in that area, Necessary, you know, I mean, you need, you need to know enough to be able to work effectively with these.
[00:08:44] Kate Grandbois: And if you don't know enough, you have to have the wherewithal to know what you don't know, which it sounds like a repetitive, ridiculous statement, but that is a cornerstone of professional maturity.
And one of the biggest things. Um, in learning [00:09:00] and continuing education is seeking out information and acknowledging that you don't know everything. Yeah. I
[00:09:05] Amy Wonkka: think
[00:09:05] Kate Grandbois: you make a good point. Yep. Um, so I think we've both been really fortunate to have a bulk of good experiences with BCBAs. Oh yeah. I mean, but we've also had a lot
[00:09:17] Amy Wonkka: of frustrating ones, I would say.
In my experience, the scales are firmly tipped in the positive, but I know that that's not the case for everybody else. I mean, I have BCBAs who I consider near and dear friends, you know, I think. I've learned a lot of really great things. And I'll talk more about that later, you know, when we're chatting, but, um, you know, it's, it's not, it's not always roses.
[00:09:39] Kate Grandbois: It's not. Um, and I think this is probably a good segue into our next section related to a history of ABA, my personal, not a history of ABA, but an overview of ABA, my personal. Um, transition into the world of ABA was because I had had so many frustrating experiences [00:10:00] that I was motivated to go back and sit for the exam.
As a way of infiltrating the enemy camp and dismantling it from the inside, because I had had so many frustrating conversations, everything related to teaching language in discrete trial format, exclusively. To using vocabulary that I didn't quite understand, like Mandan tact. Um, and I'm here to tell you that having gone through the education that a BCBA gets and being certified, ABA has a lot to offer.
It is not all terrible. And I think it has been, they just have a pretty bad PR problem. And, um, the more you learn about it, the more you realize that there's a lot that it can bring to. I
[00:10:46] Amy Wonkka: agree. I mean, as somebody who, for you listeners out there, um, Kate and I actually did that core sequence together. I made her do it.
It was good. It was good. I mean, I love learning things.
[00:10:56] Kate Grandbois: It wasn't, it wasn't a hard, no, she was like, wait, go to school for two more [00:11:00] years for no reason. Yes, please.
[00:11:01] Amy Wonkka: It sounds great. I opted not to sit for the exam, um, for a number of reasons, but I think, you know, even as somebody who chose not to go through the final process to actually become a BCBA, I took a little.
Away from that experience, I've worked in a lot of ABA based settings and I've learned a lot. It's made me a better speech, language pathologist. There's no doubt about it. Um, so while there are frustrating parts, I think on the whole, there are a lot of wonderful, wonderful
[00:11:29] Kate Grandbois: things. Yes. Um, which is again, great segue.
Let's try and unpack a little bit about what ABA is, um, so that we can then talk about how best to integrate it into our collaborative practices. So, first of all, I think we need to acknowledge that as we've mentioned, sometimes ABA has a bad reputation. But there are things that we can do to look past the bad experiences, um, and [00:12:00] embrace some of the good qualities according to, um, a great resource.
If you want to learn more about ABA, it's a book written by Cooper Heron and. Um, according to those authors, ABA is this is a quote from page 15. Um, uh, scientific ABA is a scientific approach for discovering environmental variables that reliably influenced socially significant behavior. And I think some of the key takeaways from that quote are that it's a science, um, and that it is a science applied to influencing socially significant behavior.
So these are behaviors that are, um, ha. A R very important to the individual have, uh, an, a significance in terms of improving their quality of life, um,
[00:12:46] Amy Wonkka: also for society in general, right?
[00:12:48] Kate Grandbois: Yes. Yeah. Yes, absolutely. I think that, you know, ABA is often associated with autism far too often. The principles of ABA are [00:13:00] applied to dieting, um, that they are applied to, um, exercise making me exercise.
Um, they're applied to smoking quitting smoking, um, drug addiction. And I say this a lot when I'm working with families. If I got paid and rainbows and smiles, I would probably not keep going to my job. So there are, there are principles of ABA at work. Um, ABA uses what's called the opera and model, um, which is, um, learning.
It's the concept that learning is the result of consequences that follow a behavior. Um, and that those consequences determine the likelihood that a behavior will occur again in the future. Um, that's a reference to an article by Donaldson and steamer in 2014, which is a great article that we will have posted on the web.
[00:13:52] Amy Wonkka: And I was just going to say, if you want to read more about these articles, check out our website. Yes.
[00:13:56] Kate Grandbois: We will have a list of all of these references and resources on the [00:14:00] website. Um, so that's a little bit about what ABA is, but I think it's also important to acknowledge what ABA is. So ABA often gets misinterpreted as being only discrete trial training.
And I think most of us have seen what discrete trial looks like. Particularly when teaching language it's a field of three and the student or client or individual is being asked to engage in a really specific. Response 10 times in a row, and then they get a cookie or a gummy bear. I feel like that's the, that's like the classic model, what you see in like a school or a
[00:14:32] Amy Wonkka: clinic.
Yeah. And I feel like you've also, I've heard that referred to as mass trials, right. You're doing the same thing over and over and over again, drilling,
[00:14:40] Kate Grandbois: um, doing drills language do is, I mean, I think ABA is off also misinterpreted as teaching rote communication or memorization, which is. That happens sometimes, but that's not what ABA is in general.
Um, ABA is not necessarily teaching at the table. ABA is not only for autism as we've already reviewed. [00:15:00] There is literature for the positive impacts of ABA across general education, stroke, dementia, health, and fitness, public health environment, and sustainability addiction. Um, it's even used in the business world, which is really interesting.
Um, ABA is not a curriculum and it, my favorite ABA is not bribery or manipulation. Um, I think those are casual terms that we use. Um, Um, less structured settings like parenting. So, you know, I bribed my kids with a piece of chocolate or what have you, ABA is not any of those things. ABA is a science and it can be provided in naturalistic settings.
Um, there are a lot of resources if you'd like to learn more about ABA and we are definitely going to have some of these listed on our website. The two, um, one that I already mentioned is the book applied behavior analysis by Cooper, Heron, and Heward. A lot of the people in the eighties. World, very casually referred to that as the white Bible, which it is not a religious text, but [00:16:00] I think in terms of it as a good comparison, it's very much like the language disorders book by ramp hall in the speech world, which I feel like most, most speech pathologists know what the Ray Paul book is.
We still have the Ray Paul book. I love my ramp hall book. It's like, it's my, it's my purple Bible. See, so the applied behavior analysis by Cooper Heron, and he, it is a really wonderful reference if you'd like to learn more about ABB. The BACB website is another great resource. Um, the BACB is basically an HSA for ABA.
It stands for a behavior analyst certification board, and they have a lot of resources on their website. I
[00:16:36] Amy Wonkka: also like, uh, the VB map, which is actually an assessment tool, but the guide that comes with that assessment tool contains so much information about. The behavioral interpretation of different functions of language.
I find it really concise and easily
[00:16:51] Kate Grandbois: readable. Um, yes, I'm not as familiar with that, which is probably something I should be embarrassed about. I have not used that tool as [00:17:00] much as I should have. See no, but everybody doesn't know everything. That's
[00:17:03] Amy Wonkka: totally cool. Can't read every book. That's why we're here.
You can't.
[00:17:06] Kate Grandbois: That's exactly right. Um, so. In terms of thinking about what ABA can bring to the table. Um, ABC VA's look at this same problem from a different angle. So often when we're meeting with a client, we're looking at vocabulary or syntax or quality of communication, um, and BCBAs don't necessarily have that educational background in terms of developmental skills.
But they typically don't. Yes. They typically don't. However, they do focus on quite a bit on the function of language, which when I went through, um, my I'm sure when we both went through our BCBA training, I think we found to be pretty interesting. So instead of thinking about why are you using the word cookie or should we talk about Graham cracker versus cookie versus.
Toll house. You know, what vocabulary word are you using? The BCBA is [00:18:00] looking at what reinforcer is in place that is motivating the individual to use that word in general. So it's more about the interaction between the use of language and its impact on the environment and what consequences are, what consequences follow, um, that make that communication exchange happen.
Um, There is a lot, BCBS get a lot of education in measurement and how to measure these kinds of things, which is something that I think is very, um, Uh, contributing factor in terms of what they help me out here. Oh, I
[00:18:36] Amy Wonkka: feel like the data collection piece. I mean, that was my jam. Right. I love data. Um, and so for me, that's one of the pieces where I've connected with the PCPs in my life, um, is the ability to manipulate and consider different ways.
Solve the problem of the clinical question that you're posing at that time. Right. So what is a way to collect data that's [00:19:00] unobtrusive and gives me the actual answer that I want. And doesn't take away from the therapeutic integrity of, you know, the interaction I'm having with a client. That's, you know, your BCB is, can really help you out a lot.
There. I feel like, you know, I mean, I'm like medium old, but when I, when I went to grad school, there was, you know, there, there was a lot of emphasis on, you know, kind of trial by trial data and, you know, Became the criteria for a lot of goals and objectives. Um, that's, that's not always the best way to think about it and that doesn't always get at the skill that we actually want our clients to achieve.
And so I think that the, the different ways that BCBS are able to look at and, um, considered collection and analysis of data, uh, All all allied health
[00:19:43] Kate Grandbois: practitioners practice. I think it's a really nice way to bring a BCPA into the conversation. If you're, especially if you're having a disagreement is to talk about their skills and how to make.
Certain behaviors. Um, to be honest, they get a much better education in this [00:20:00] than speech pathologists. Do it's much more detailed
[00:20:02] Amy Wonkka: wouldn't you agree? Yeah. I mean, if I had to like, be a bit crass about it and break it down, I would say that speech language pathologists get a lot of information about content.
We are content experts, right? We're not experts, we're experts. Um, and when you think about BCBS, I feel like they get a lot of education, an application, right? So they can help us take the information that we know and apply it in a way that lets our client be successful in acquiring the skills that they, we want them to have, um, where they fall short.
Typically, you know, in my estimation, Around that content. So I think, you know, when we have successful collaboration, it really is the best of both worlds for the people who were supporting.
[00:20:42] Kate Grandbois: Definitely. Um, and I think when you do end up bringing in those qualities, bringing those qualities into the fold in terms of looking at function, you know, How better you can measure an individual's communication.
You're really looking, you are meeting those ethical standards. You're holding the [00:21:00] needs of the student or client most paramount, and you're improving services across the board. And that's not just for the client or student. That's also for the family. So keeping in mind, particularly for our students, with autism or clients with autism, a lot of these individual.
30 40 hours of ABA a week. And how confusing is that? If your speech pathologist is saying work on core vocabulary and your behavior analyst is saying no madman meant that is incredible. Disjointed in terms of a collective treatment package. So when you're bringing the BCPA in and collaborating with them effectively, not only are you improving services for the client, but you're really helping to ease that burden for the entire family, not to mention the sheer number of hours and the way that BCBAs bill.
So speech pathologists, we typically do. If you're in a school, a handful of, you know, you know, 30 minute sessions based on the documentation and the IEP. Um, maybe if you're in private practice, you're getting 1 30, 40, 30 minute, [00:22:00] 45 minute, one hour session a week. Um, The BCBA is outnumbering you in terms of the number of hours that the student is getting, they're getting 30 to 40 hours.
So if you can make that collaboration happen, you have this wealth of time where you can get your student or client to be practicing some of this. That you want to be practicing.
[00:22:21] Amy Wonkka: And I would say in most of my experience, you know, it's not the BCBA who's providing that like large aggregate number of hours.
It's, uh, it's a paraprofessional level staff. Um, but the difference between, you know, the speech language pathologists and the BCPA would be that the BCBS. Is actually able to bill for those indirect hours of providing supervision to that staff. Whereas we're more jealous feelings.
[00:22:43] Kate Grandbois: I know, big jealous feelings I'm listening out there who feels like taking on an advocacy project.
Right. We need more boots on the ground to advocate for different billings director.
[00:22:53] Amy Wonkka: For sure. It's a separate podcast, mate. It is a different podcast. Yeah. But, but if, you know, if you can get in with the BCBA and you guys are aligned and you're on [00:23:00] the same page, that's one more person who's making sure that the paraprofessional staff who's working with your client is also following through, you know, with your, with your goals and your recommendations.
So, you know, another big piece of that. Often, you know, the is in the home. I know Kate you're in private practice. So you might have the opportunity to be in the homes more than, you know, those of us who are in outpatient or schools. Um, but if you have a BCB who's going into the home, being connected with them is going to help, you know, your, your client generalize those skills across environments, and they can bring back new information for you to about, you know, maybe this thing is meaningful.
In terms of, you know, connection to the third grade curriculum, but there's this other piece at home that would also be super meaningful for this client and their family. Um, so, you know, the BCBA can really be a very helpful liaison. Well, I
[00:23:49] Kate Grandbois: agree. And that sort of brings us to another point. The, there, the correlation between individuals who have.
Uh, communication disorder and the behavioral [00:24:00] issue is really high. I can't tell you. I have a, I'm having coffee with, um, a fellow colleague of ours next week because, um, in her private practice, her clinicians are having a really hard time just getting her clients to crawl out from under the table. There are so many refusal behaviors or noncompliant.
Because for so many of our, I guess, pediatric clients, they develop unwanted or maladaptive behaviors in place of communication, because communication is so hard. So, um, there are probably millions of instances out there where the client you're working with also has behavioral needs.
[00:24:39] Amy Wonkka: And this is where, you know, I think back I'm sure everybody who's listening.
Who's who's a bit longer in the tooth. Can think back to
[00:24:54] Kate Grandbois: No every
[00:24:54] Amy Wonkka: day to folksy horsing. Um, so, you know, you can think [00:25:00] back to when you were first out of grad school and you look back on things and you're like, oh my gosh, I can't believe I did that again. Right. So, so I think behaviorally that's true for me as well. I, I definitely, you know, to use the terminology from ABA, I reinforced problem behaviors completely inadvertently, cause I didn't realize it.
Right. So, you know, a good example is I have a client and they're in on the swing and. Pushing on the swing and they get upset. And I can tell that they're upset and you know, maybe they, maybe they hit me because they're feeling so upset and I can tell. You're upset because you want more swinging. And so, you know, what I do is I I'm, you know, maybe model more swing and then I pushed them on the swing.
Um, you know what my behavioral colleague might say is like silly mughelli you just, you know, read
[00:25:44] Kate Grandbois: them more, give them more
[00:25:45] Amy Wonkka: swing for hitting you. Right. So you just made it more likely to in the future, because back to what Kate was saying earlier, you know, when you look in the behavioral paradigm, you're thinking that what happens after behavior makes it more or less likely that it will happen in the future.
So when, you know, I [00:26:00] think back to that moment where, you know, I pushed the client on the swing because they hit me because I knew what they wanted. Um, I just made it more like. Because that was what they wanted. Um, but if I were working in concert with, uh BCPA or somebody else, you know, who had that behavioral background, um, you know, and even having that knowledge now I would, I would do that differently.
So I think, you know, there, there are behavioral challenges where it impacts your effectiveness as a therapist, but also. Just like other people may undo what we want to do. We could be undoing. There are these totally by accident.
[00:26:33] Kate Grandbois: And I think, you know, there are other that's, you know, the spectrum of problem behaviors is so wide.
So there are problem behaviors that. I guess we'll say mild, you know, they're not dangerous. They're not negatively impacting the individual or a family quality of life to a significant degree. If anybody has any toddlers, we know what that looks like, you know, typically developing toddlers. Um, but you know, in terms of the spectrum of special [00:27:00] education, um, at least in pediatrics, there are more severe problem behaviors.
And this is, this is my personal clinical area. Um, when you have an individual who's engaging in significant problem behavior that is unsafe, or that is, um, you know, dangerous to other individuals or themselves, there is a time where you may need to take a back seat and as a speech pathologist. And, um, that can be really tricky.
I've had a handful of instances in my career where I've been asked by the parent. Um, some else, someone else in the school to come in and facilitate, try and make some recommendations for better language, because they want the individual to be commenting where they want them to be using core vocabulary.
And I arrive and the individual is head hitting at such high rates that they've given themselves concussions and they're breaking their facial bones. And, you know, there are extreme situations out there where yes, I would love that individual. I would love to be able to teach that individual to make comments and to use core vocab.[00:28:00]
However I have enough wherewithal to say, okay, but that's not the most important thing for that individual from a safety standpoint, and being able to acknowledge that and sort of support the behavioral team. As a primary person for intervention, because that's, what's most important for that. I mean, I, and I know that's like the more extreme side of things, but there are times where behavioral needs supersede communication needs.
[00:28:27] Amy Wonkka: Well, and I know the focus of this podcast is BCBS, but, you know, thinking about our collaboration with occupational therapist also, you know, I mean, I think we know. When you're regulated and when you're available for learning, you're available for learning. And that, that runs the gamut. That's, that's true for adults.
That's true for young children. Um, and so, you know, in the case that you're describing Kate like that, that person's not available for learning, right? So whether those are the ultimate goals or not like first, the team needs to work together to make sure they're at a place. They're in a place where they [00:29:00] can learn, like, you know, none of us is doing our best work when we're at crisis level 20, you know, it's just not, it's not compatible regardless of, you know, your unique characteristics as an individual.
Right. And
[00:29:11] Kate Grandbois: that's a, that's a by-product of being human. I mean, I know my husband was recently in a meeting where he was so nervous that he lost his words because he, his anxiety was really high. He was working at a level 12, like you said, he was not available to perform his best work. And I think that relationship between emotion and communication is true for everyone, um, to a certain degree.
Um, so now that we've sort of covered why we should collaborate with BCB CBAs. I think it would, maybe this would maybe be a good transition to talk about strategies for when that collaboration, when you, when you, when you, when you as a professional have acknowledged. That collaboration is important that you see the players involved and that you're willing to collaborate, but either that person is a prickly pear [00:30:00] or they're recommending things that you think are inappropriate, or maybe there's a third party, like a teacher or a paraprofessional or parent who is making that collaboration more difficult.
[00:30:10] Amy Wonkka: Yeah. Yeah. So, I mean, how do you wake up? Make it work? I feel like for me, if I had to classify it, I would put it in like three big. Buckets of barriers, right? So there are, you know, logistical barriers. I feel like logistical barriers are real, even if you know, I know some of your terminology, um, and I'm, I'm on board, you know, emotionally with trying to be flexible and like Columbia.
If we don't have time, we don't have time. Like effective collaboration takes time. Uh, no matter who you're collaborating with, no matter what the context is like, you, you need time. That's a real, that's a real barrier and it varies by setting. It does. It does. And, and I feel like the solutions to that problem depend on the setting too.
I mean, when you're outpatient, it's hard to make time for when I worked out here. [00:31:00] Most recently I was per diem. I was at night. So I'm trying to collaborate with school providers, but I can't. Cause I have a second job during the day,
[00:31:06] Kate Grandbois: plus they're not going to pay for that. You're not going to see not part of your
[00:31:09] Amy Wonkka: productivity.
No. So it's so it's really hard. So when you're in a productivity driven model and perhaps you're working offset hours with the people who you're trying to collaborate with, you know, I mean, what are your options? I, I personally think face-to-face is best, especially if you're going to have a potential disagreement.
Cause when you see someone's face, I'm looking at Kate's face someone's face, you know, it's, it's harder to be really grouchy with them. Right. But it's even if you want
[00:31:38] Kate Grandbois: to be grouchy or you feel grouchy, it's so much easier to do that over email. Than it is to a person's face, correct? Correct.
[00:31:46] Amy Wonkka: So, but let's say you can't do that, right?
Because you work nights and the school people work days and nobody's paying you for it anyway. Right. So second phone call. Can you coordinate a phone call? Do you have like a cusp hour where like, you've just gotten to your second [00:32:00] job and they're just wrapping up their job. Maybe you can call that's better than emails, which are an option.
And technology's great. But like, have you ever tried to navigate a frustrating experience over email? Get the worst so bad. It's I just did it. I just got in a fight with my health insurance company. Do
[00:32:21] Kate Grandbois: you sometimes, do you write an angry email and I just let it sit in your draft box because you can't send yes.
That's my only, that's my only choice because I have no other way to effectively. Dismantle the argument and use some of the other strategies that I have to be like. Sometimes if you're having a prickly pear disagreement and you just smile or you just say, Hey, I like your pants. You can diffuse a lot of the disagreement and just have a human moment and you can not do that over email.
[00:32:51] Amy Wonkka: Emojis only goes so far and they're
[00:32:53] Kate Grandbois: cheesy. They're, there's no place for those in a professional exchange sometimes.
[00:32:57] Amy Wonkka: No. So, so those, I mean, I think that those [00:33:00] are, those are real challenges. Those are real barriers. They're logistical. Um, you know, I think thinking about making connections with other people and kind of all the pieces that go into that, you know, making it as in person as you can, would be.
Uh, tip, um, if you can't do it, be cognizant of the fact that emails don't carry tone and emotion as effectively as you'd like them to. Um, so, you know, then, then like having worked in schools, it's a little different, like in, uh, in private schools, I've worked in a couple of private schools. They tend to program that time into their day.
You know, like it might be, everybody comes in at seven 30 on Tuesdays. You
[00:33:39] Kate Grandbois: mean private schools for substantial. Separate special ed. So not necessarily private, like regular privates, well, general education, private schools. Correct. But private schools for a substantially. Separate am I saying that right?
Yeah. Substantially separate setting. Yeah. Substantially every center, um, and a more
[00:33:56] Amy Wonkka: restrictive setting.
[00:33:57] Kate Grandbois: And I also feel like, um, [00:34:00] You know, for Amy, you have done a really great job advocating with your administration to make sure that collaboration, that they acknowledge that collaboration is important. I know Asher has some literature on their website about embracing the three to one model.
I don't know if you want to talk about that a little bit. Cause I feel like. Especially if you're doing consult once a week, once a month
[00:34:21] Amy Wonkka: or whatever. So when you think about public schools in public schools, you know, you're documenting your time and your consultation time and the IEP, I would definitely advocate for people to think about what amount of consultation they really need to be effective.
Thinking about the three, one model, the three, one model, Asher has a lot of great resources about the workload approach to caseload, which I have found is difficult for public school administrators sometimes to wrap their heads around. Um, the three, one model is a way to sort of encapsulate all of the indirect services that would be captured in a workload approach approach to caseload, uh, in.[00:35:00]
Three of the weeks within a month, you're providing direct service. So that would be your B and secret service for the IEP. And then in the fourth week, you're providing indirect service and it sort of set aside your designating that time in the acre, that indirect service grid of the IEP, um, and your, your making time for all of those services, which are really essential.
Um, and I think looking to Ashleigh, looking to their resources on workload approach to approach to caseload is a really great tip. They have a lot of, they have a lot of information there
[00:35:34] Kate Grandbois: and if you're not in the schools, if you are in an outpatient setting, Advocating to your administration or to your supervisor, particularly if you're working with complex learners, individuals with autism individuals, with complex medical backgrounds, being able to set aside a certain amount of time to collaborate with their physician or their OT, outpatient, OT, or.
You [00:36:00] know, any, any of the home ABA service providers, being able to make sure that that time is set aside for you can not necessarily increase your productivity productivity from a monetary standpoint, but can do a lot of other really great stuff for your
[00:36:14] Amy Wonkka: clinic. And I don't see any reason why the workload information that's on the actual.
Couldn't be utilized to have a conversation with administrators in different employment settings as well. Fair
[00:36:24] Kate Grandbois: point. This is what best practices. And if you need to translate it to your administration for budgetary rules. Customer service, um, you know, making sure that the families feel that you're putting in the extra time to help collaborate and, um, integrate things across different settings.
Yeah, for sure.
[00:36:42] Amy Wonkka: The next big barrier. So we've got our three buckets of barriers, bucket. Number one is logistics. I would say the next big barrier would be knowledge based, right? So, you know, I'm not a BCBA, Kate's dual certified. We did both take the coursework and which we've not mentioned multiple, multiple times, multiple times.
So we're, we are, [00:37:00] uh, we, we took the classes and we learned things. Um, I think, you know, I think when you, when you make a commitment like that, it really helps you with your collaboration. I think it was very helpful for me to learn what their words mean. And now I can use those words in a conversation. And feel pretty confident that I know that I know what they're thinking.
When I use those words, it allows me to redefine my terminology using their terminal. You don't have to make that commitment. Um, but I think, you know, thinking about doing a little reading so that you can use the same jargon, I do feel like professional sometimes. Like when we get our hackles up, we just go, we go all in with the jargon.
[00:37:38] Kate Grandbois: I think that the ABA world in particular has so much Turkey left. We have jargon, like most people don't know what a UV light. But I don't, I wouldn't say the dangly thing the back of your throat. I wouldn't say uvula because I know that the lay person does not know what that is. And for some reason, the ABA world, you know, Skinner, he was, he was a genius in so many ways, but when he made up all [00:38:00] these words, he, um, when he made up all these words, he really sort of threw a, threw a wrench into things.
Um, and I think that. Just to your point earlier about having your hackles up, you know, when you have these difficult conversations or you have a BCBA you're working with that is, is a little bit of a prickly pear. It might be a great idea to ask them. So what do you mean when you say. If you don't have the resources or the time to go take a course or a do flashcards or read verbal behavior, you know, we ask them, you know, make, you can disarm their anger or defensiveness by trying to engage in a collaborative discussion so that you can learn so that you can sort of say to them, I don't know everything.
I'm hoping that we can collaborate so that I can learn something from you. And by doing that, you might be able to disarm them a little, not disarm them. Okay. Make the exchange a little bit more [00:39:00] friendly instead of defensive.
[00:39:01] Amy Wonkka: Yes. And I mean, we could also be the prickly pear. Like sometimes, maybe I'm the prickly one in the commerce could be, you could be, you could disagree with.
I could always write, accept an email and then I'm just to ground Shannon, you
[00:39:16] Kate Grandbois: leave it in your Dropbox, right? Like a rational, sane, human being.
[00:39:20] Amy Wonkka: No, my, my poor health insurance lady got up to email. Um, but, but I think, you know, thinking about, I, I work in, in my current role, I work with augmentative and alternative communication and we talk about.
About using core vocabulary. So using high-frequency vocabulary to define fringe vocabulary so less, less frequently used in more specific terms. And I think, you know, that's a helpful exercise to, you know, w what is a manned, um, how would you define it using
[00:39:49] Kate Grandbois: so request, but it's a very specific definition and is not always the
[00:39:53] Amy Wonkka: no, and I, and I think, you know, an exercise like that is helpful because then we could together.
I [00:40:00] realize that, you know, in, in speech language pathology, there are like three or four terms that a BCBA would consider a man. Right. So they would consider, you know, uh, reject protest refusing, like all of these things that I would consider. As, as different Lee classified, um, functions, they all kind of group under this one term of man.
So going through that exercise can be helpful because then it also helps them have the perspectives that we're thinking about it in all of these different ways. Um, you know, we mentioned earlier, I think the biggest benefit for me in collaborating with and learning about ABA has been the data collection piece.
I mean, Thinking about, you know, is, is 80% really the criteria I want. Do I want this person to just increase their frequency of doing something? Do I want them to increase their independence and their frequency? Thinking about different ways to collect that data and the idea that like, maybe I don't need to write a million pluses and minuses on a post-it note.[00:41:00]
I can just collect data on the first time you did it. And if you did it independently and accurately, the first time we looked at that page in the story, I can just be in the, in the therapeutic moment with you and a don't need to be. Half present, because I've got to scratch all these things on a post-it note.
I think that
[00:41:19] Kate Grandbois: the, I think that the data collection piece is also a really great way to diffuse arguments. So how many times have between the two of us been in a situation with the BCPA, um, where they think. Nope. I don't think that this student should use touch chat. I don't think they should use lamp. We were both EAC people.
Um, I think that they need to use sine. I think they need to use PEX or they have some other recommendation and there's this big to-do over whose territory it is. And who's making the right call. But you have to work with this person because the parents think that they're great or because they're in the home or because they work at your school and you [00:42:00] have to work together as a team.
And this is something that I learned from me. Take the data, do it, just let the numbers speak for themselves. If you feel like you don't have it in your wheelhouse to you to design the data collection system, let the BCB do it. Listen, BCBA, you are so super smart with all of this data collection system.
Just tell me what kind of data to collect. And then I will take data on my tool and then we'll take data on your tool and we will see what happens. It's a great way to flush out. Without making it a pissing contest. It's
[00:42:31] Amy Wonkka: also really good practice because one of the things that I love about data and I do, we've had this, we've had a version of this conversation multiple times, but I feel like, you know, data does take, take your kind of beliefs that out of it, there are times when I've thought that something would be very effective and then we collect the data and it wasn't.
And so that's, that's my job. That's what I want to know.
[00:42:54] Kate Grandbois: Great. Is that BCBAs are driven by data. So if you're having that argument or discussion. [00:43:00] Then the numbers speak for themselves and they sort of have to acquiesce depending on, you know, how it flushes
[00:43:06] Amy Wonkka: out. Well, and then you were collaborating to solve the problem together instead of like having a sassy battle.
Right. I don't
[00:43:13] Kate Grandbois: like sassy battles, but I like that phrase
[00:43:16] Amy Wonkka: sassy battles. Yeah. It's battles. Nobody wants fun, but it's fun to say just like uvula. No, you didn't want to yellow, but it's also fun. It's just the UVA. Should I know that speech science people could tell us that if somebody
[00:43:27] Kate Grandbois: wants to email us and tell us what the uvula does, that would be great.
You
[00:43:32] Amy Wonkka: feel would be helpful.
[00:43:36] Kate Grandbois: Oh, oh, they're so
[00:43:39] Amy Wonkka: good. So, so barriers, we've got logistical barrier. We have terminology and like knowledge barrier. Our last barrier I would say would be kind of the social relational barrier. Okay. That's fair. And that's real, right? So you have the information. You allocated the time in your schedule, but you still, like, it's not working.
It's probably a social, it's probably a social barrier. [00:44:00] Um, collaborating with the
[00:44:01] Kate Grandbois: meaning. The person doesn't have great social skills. No, or
[00:44:05] Amy Wonkka: no. I mean, I suppose that could be part of it, but more just like you don't like the person types, you just don't really like people that's fair. Right? Like that's real.
I, I have a very socially focused job and I'd like it to be real quiet and just me and my daughter.
[00:44:21] Kate Grandbois: Um,
[00:44:23] Amy Wonkka: no, I feel like, I feel like it's more just like sometimes you, you meet people and you're like, we could be friends.
[00:44:28] Kate Grandbois: Right. And that's so much easier to collaborate and easier to disagree. Yes. When you're friends, I think more importantly.
Yes.
[00:44:36] Amy Wonkka: Just grants.
[00:44:36] Kate Grandbois: Yes. We disagree quite a bit. Yeah. That's why I was saying earlier that you argue with a smile, I disagree
[00:44:41] Amy Wonkka: with a smile. Cause you do pay on time. We do fight. Yeah. So I feel like, you know, if you, like, you're not going to like everybody, not everybody needs to be your friend, not everybody's going to like, you know,
[00:44:52] Kate Grandbois: No, that's just a that's just
[00:44:53] Amy Wonkka: life.
I know. And so, you know, you have to find a way as a professional to like work around that and be like, all right. I don't [00:45:00] really like you, we will never go out after work together ever. Um,
[00:45:04] Kate Grandbois: you feel like sometimes it helps to make an effort for social niceties. And I want to, I keep saying I like your pants, but you are not necessarily complimenting their aesthetic, but how was your weekend?
Did you have a nice break? Just taking a humid, a moment to be a human, a moment to have a human connection. Yes. Not necessarily take a vested interest in their life, but find some sort of common ground to have a nice exchange outside of the topic that you're collaborating
[00:45:33] Amy Wonkka: around. So like be a person, not a jerk,
[00:45:37] Kate Grandbois: be a person don't be a jerk.
Don't be a jerk. I think that's a
[00:45:40] Amy Wonkka: great expression. Yeah. So, so I think that there are two back to these terms, like there's an interim professional challenge, right? So when you're coming full circle, I know it's like within yourself, right? So within myself, It's an, it's really an interpersonal issue, right?
Like I'm making an active choice. I've identified. I don't like Kate [00:46:00] so much. Right. But I know I have to put so sad and I love it. It's okay. Um, but like we have to work together, right. So we have to work together. So it gets a challenge, a professional challenge within myself to like find a way to be kind of see you and like cultivate.
Nicer thoughts toward you recognizing that we're, you know, we might never be friends, but I have
[00:46:21] Kate Grandbois: to say, I feel like this bucket, this interpersonal bucket is a cornerstone for successful collaboration. So even if you don't agree, just finding a way, finding the strength or emotional bandwidth within yourself to be kind, to be professional, to be human and to not be a jerk, especially when the other person is maybe a jerk.
[00:46:42] Amy Wonkka: Well, too, like, you know, Use your perspective taking skills, right? I, I see sometimes what I'll see is I'll see disagreements between, let's say a veteran speech, language pathologist, and somebody who's new to the field as a behavior analyst. And I think back to my example, like I can look back on things that I [00:47:00] did as a brand new speech pathologist when.
Knew so many things, you know, like I was, I was graduating. Like I can do
[00:47:06] Kate Grandbois: everything. I'm going to change
[00:47:08] Amy Wonkka: the world. I had a lot of confidence. I had a lot of like grand views. And I think even just that piece of being able to like reflect back to maybe what that moment felt like for you as a professional, as a person, and see that maybe part of like when someone is coming on really strong, like that's also probably coming from a place of like all of this passion and excited.
For their field, you know? So just so trying to do a little bit of that perspective, taking and thinking about, you know, maybe what it feels like as this person is being rigid and pushy and bossy, but perhaps the way that they're thinking about it is like, they so much want to help this client. And they really feel so passionately that like, this is the best way to do it.
Um, and, and not. Taking their perspective, like changes everything. But I find for me, it helps me cultivate kinder feelings. [00:48:00] And that leaves me open to creating the structure where we can have a better relationship.
[00:48:05] Kate Grandbois: And I think that that's a really nice way to avoid being territorial because if you, and if you approach any exchange, particularly one that might be contentious with an email.
All bets are off, nothing functional, nothing collaborative, nothing positive is going to come out of that exchange. Um, and, and especially when you're working with BCBAs, who. To be honest, feel that communication is within their scope of practice. Um, you know, there is this debate about whether or not that's true, um, which is probably a whole, I'm looking at the time.
That's probably a whole other podcast we could do. But when you're working with a professional, you know, when you're collaborating with an OT, you're not entering the exchange thinking, oh, well I know a lot about sensory integration or I know a lot about fine motor skills. Oh.
[00:48:51] Amy Wonkka: But we fight about feeding.
But, but feeding.
[00:48:53] Kate Grandbois: Okay. So perfect. Feeding is maybe that one shared area and the shared area with [00:49:00] BCBS, I feel like is, is much larger and, and goes across feeding and AAC and language development and communication in general. You're talking about an exchange that has a lot more potential to be explosive because you're sharing so many or quote, unquote sharing so many more areas of your scope of practice.
Well, and I
[00:49:21] Amy Wonkka: think that gets at the second piece of that kind of interpersonal social component, which is, you know, the, the social aspect of the interprofessional relationship, um, which really is, you know, that knowledge. And, um, vocabulary piece that, you know, is a barrier for us in not knowing their, you know, their jargon and not understanding their terminology.
They, the BCBA is have that gap for us as well. So the social burden on us is to be able to have cultivate, uh, a solid enough working relationship that we can provide that education, even if it's not [00:50:00] necessarily something that, that BCB would have sought out on their own. So kind of demonstrating, you know, We, we did lots and lots of credits in school where we learned a lot about language.
We learned a lot about phonetics phonology. We can write in this magical language of IPA. You know, we have all of these, you know, components that they're not even aware, um, potentially are. And from our information that we keep. And so, you know, by having an established relationship where you're able to share that in a way that doesn't feel like you're jamming it down their throat, but it's also assertive.
Like, I mean, collaboration is not. Just giving up and like letting some other professional rule the roost, like the other big piece of our code of ethics is we need to do what's best for our client. And if that means having a professional disagreement that that's that's and it's
[00:50:48] Kate Grandbois: okay to disagree. I think this is another thing that I've learned from you over the years is that disengage disagreeing doesn't have to mean fighting.
Disagreeing can be a professional. Hey, man. It's cool. We can [00:51:00] still be friends. We can still work in the same place. We can still have social niceties and not agree on this one thing. And that is
[00:51:07] Amy Wonkka: okay. So I had a boss a few years back who, who provided me with this bear, very powerful phrase that I continue to use to this day, which.
We can agree to disagree and that's okay. Yeah. That's okay.
[00:51:21] Kate Grandbois: It's it feels uncomfortable. I feel like conflict is not something that we culturally embrace and it's not something that people enjoy. It's not, it's not something that's pleasant. So I think a lot of times it becomes contentious by accident just because it just because it that's the default, but it doesn't have
[00:51:39] Amy Wonkka: to be that way.
And I find that to be. I mean, I use that phrase a lot. I've used it multiple times, but you know, I think it's a nice, if you feel like the conversation is getting too heated, it's a good stopping point to just say, you know what? I think we're just going to agree to disagree on this and that's okay.
[00:51:57] Kate Grandbois: Okay.
And making sure that they know that that's okay. [00:52:00] Um, I also think that by doing that, you're modeling mature. Your mom, you're providing an opportunity for, for learning for additional learning between yourself and the person that you're disagreeing with your modeling. Um, you know, you're providing an opportunity to show other A's or other younger speech pathologists, or maybe not even younger, but greener speech pathologists, new graduates on how to navigate some of these tricky waters.
So. It's a nice way to identify that as an area of professional development and go into the difficult conversation, knowing that you, you might just have to
[00:52:38] Amy Wonkka: disagree. They're also in the resources on our web page, there is a link to, um, a book called difficult conversations, uh, which is also a very helpful.
Just about having difficult conversations with other
[00:52:51] Kate Grandbois: people. Yeah. It's difficult. Conversations are real. They happen. Um, okay. So I think
[00:52:56] Amy Wonkka: that pretty
[00:52:56] Kate Grandbois: much concludes the, um, [00:53:00] three, the background information background information about ABA. And, um, the, um, strategies for how to collaborate. Um, I guess in summary, collaboration is really important.
It's part of our ethical code. Um, even though ABA may have a little bit of a PR issue and you may have had some difficult conversations or difficult experiences with BCBAs, um, ABA is not, is not the devil's work. have a lot to offer. Um, the science of ABA is something that's pervasive everywhere. It is not related just to, um, autism or discrete trial.
And we definitely encourage you to have, um, a little bit of an open mind and going into collaborating with BCBAs. Um, and we of course are here to get feedback. There is an issue that you would like some guidance on or [00:54:00] something else that you would like to talk about. Where can you guys find some more information?
So, as Amy mentioned, we have additional resources posted on our website. Um, there is a great article that we referenced, um, called team collaboration, the use of behavior principles for SU for serving students with ASD, which was published in language, speech, and hearing services in schools, um, by Donaldson and steamer, there's the Cooper heroine, Howard Cooper, Heron and Howard book, the BACB website, the Ash code of ethics.
And
[00:54:33] Amy Wonkka: you can look on Ashleigh, sorry. On Ashleigh. There's also going to be links on our website to their information about workload approach to caseload. Uh, and then the difficult conversations book by stone Patton and heme will also be listed on the website. Okay,
[00:54:46] Kate Grandbois: excellent. Um, and finally, if anybody out there is interested in becoming a BCBA, the BAC B the BACB changed their rules for taking the seven courses.
Just this past year. So if anyone out [00:55:00] there is interested in becoming a PCBA or has considered it, definitely reach out and send us an email, um, I, we would both love to talk more about it. I think while we have the same education, I sat for the exam, Amy didn't, but I think we can both agree that it added quite a bit to our clinical practices and was worthwhile.
Definitely. For sure. Definitely. So in closing, just to review this podcast can be used for continuing for certification maintenance hours. Just go to our website, www.slpnerdcast.com. Click on the episode and then click on get CEOs. You will be guided to a quick three question post-test and then we will email you a certificate of completion attending.
Anything else? No. Nope. That's it. Thanks for joining us. Thank you so much for joining us. Stay tuned for our next episode on aided language stimulation. Very exciting. [00:56:00] Well, thanks again, everybody for joining us and we will see you next time.
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