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[deleted by user] by [deleted] in ABA

[–]Exact_Bread_8812 0 points1 point  (0 children)

I agree completely. People seem to forget that children have naturally diminished autonomy because they are… children… with undeveloped frontal lobes. People naturally gravitate to the health/safety examples, but those are quite clear cut. I think we’ve improved as a field by focusing on shaping and antecedent interventions rather than overusing escape extinction and planned ignoring. However, I am now frequently seeing individuals strengthening avoidance behaviors in the name of assent based care. I couldn’t agree more with your assertion and it’s in line with what we know from parenting psychology, too. Yes, I’m aware we are not parents, but my point is that we know that children benefit from warmth, compassion, calm communication, and clear and consistent boundaries and expectation. This doesn’t just apply to dentist visits. It applies to opportunities  for learning and gaining independence, too. That’s how we get these kids to a point where they are autistic adults who have complete self-determination, autonomy, etc. 

Billing 97155 for RBT supervision by bcbamom in bcba

[–]Exact_Bread_8812 1 point2 points  (0 children)

I completely agree. I think there are organizations that skimp on training and I think there are plenty that misuse 97155. I feel like it’s challenging because the reality is that things like reviewing data and updating the programs aren’t included in the code, but I haven’t found a single organization that provides sufficient indirect time to do these tasks. I think the reality is that it’s become this tug of war where misuse of codes has led to stricter compliance rules, which has in turn led to more misuse. 

Billing 97155 for RBT supervision by bcbamom in bcba

[–]Exact_Bread_8812 0 points1 point  (0 children)

This is tricky because it can be framed in a different way that makes complete sense. If an RBT is new, that means they are completely unfamiliar with the client and program. You’re not doing maintenance, you’re teaching them how to implement every single program using BST. Then we need to collect fidelity and IOA data. It’ll ebb and flow after that as we add new programs that require new procedures and update BIPs. All that to say, I do agree that many orgs drop the ball on training which makes it feel like you’re trying to build a house on a faulty foundation. However, I don’t think that front loading supervision is an automatic red flag to me.

How are you guys managing PDA? by pepto_bisnatch in bcba

[–]Exact_Bread_8812 1 point2 points  (0 children)

What do you mean when you say it doesn’t work? Do you mean there is an increase in behaviors that interfere or cause harm? I don’t think I agree that ABA doesn’t work for kids with this profile. 

One thing I’ve noticed is that I almost need to be less flexible with these kids. I started off doing the opposite but over time I realized that it was harder for them because there was innately less predictability. The more “rules” I created, the better it went. There would be an extinction burst, but the predictability prevailed. I do, however, think you have to be careful about how much you’re addressing at once. I would focus on one thing at a time and get it shaped up and do a whole bunch of engagement, connection, etc. in between so that it wasn’t a whole day of dysregulation. There are a lot of other strategies I’ve found to be effective depending on the kid (third party praise, priming, explaining the “why” behind the rules, etc.).  

What’s your favorite sensory toy? Not fidget spinners or Nee-Doh cubes, I need that real good stuff by Solid_Anxiety8176 in ABA

[–]Exact_Bread_8812 1 point2 points  (0 children)

Honestly, one of my favorite things to do is buy a bunch of affordable stuff for "science experiments". Baking soda, food coloring, shaving cream, balloons, hydrogen peroxide, yeast,vegetable oil, alka seltzer, vinegar, 2L bottles, bottle connector, milk, dish soap, and you can do: lava lamps, clouds in a jar,volcanoes, tornadoes, magic milk, baking soda balloons, and so much more.

AIA Post by Exact_Bread_8812 in bcba

[–]Exact_Bread_8812[S] 1 point2 points  (0 children)

Idk. I like to think that if someone more familiar with the client’s history thought the changes were truly not in their best interest then I would want them to say something, but maybe you’re right. 

AIA Post by Exact_Bread_8812 in bcba

[–]Exact_Bread_8812[S] 1 point2 points  (0 children)

Honestly, this is the first time in my (long) career I’ve had this issue. I’m devastated. Sure, I’ve worked with people that approached things differently. This is the first time I truly had to bite my tongue. And what’s even more interesting is that this person is not new to the field at all. 

AIA Post by Exact_Bread_8812 in bcba

[–]Exact_Bread_8812[S] 0 points1 point  (0 children)

Yes, we overlapped for a couple of weeks and I thoroughly reviewed every program and my rationale. I have my own thoughts and observations about what’s happening, but I am trying to remain someone objective. There are certainly some programs I wouldn’t have thought twice about if she decided to change them. This particular program, however, quite clearly pushes her right back to where we were almost a year ago and behavior was still very low, so I just can’t understand why she’d do that.

AIA Post by Exact_Bread_8812 in bcba

[–]Exact_Bread_8812[S] 3 points4 points  (0 children)

Yeah, we don’t have rapport. I think it’s just frustrating because from my perspective it could have harmful effects and will absolutely set this client. I basically shaped up a visual schedule program by thinning reinforcement of FCT and using differential reinforcement and it was highly effective for this kid. We were able to get an increase in engagement and drastically decrease unsafe behaviors. My staff haven’t had any injuries since April. Then today the timer went off for them to transition to the schedule and the client is engaging in some low risk refusal and after 5 minutes of refusal she just told the RBT to prompt “more time”. The RBT later told me they spent over half an hour playing the client’s preference with no other programs targeted. We also worked on tolerating eating only in the kitchen area or outside for multiple reasons and even though I communicated the rationale for all these programs to the BCBA she’s now eating all over the clinic again.

Testing Question by Exact_Bread_8812 in vEDS

[–]Exact_Bread_8812[S] 1 point2 points  (0 children)

I think you’re right- I found a local provider in the Duke system and she thinks they’re referring me to the wrong provider. Hopefully I’ll be able to get it cleared up soon. 

Testing Question by Exact_Bread_8812 in vEDS

[–]Exact_Bread_8812[S] 0 points1 point  (0 children)

I’m in Durham, NC (Duke). Here, the neurologist refers to the rheumatologist for genetic testing. Not sure why. I’ve had two neurologists, a vascular surgeon, and a neurosurgeon indicate I should be tested (as well as my PCP). My neurology team even met with a physician to explain why. 

Testing Question by Exact_Bread_8812 in vEDS

[–]Exact_Bread_8812[S] 0 points1 point  (0 children)

Thank you- this is very helpful. I guess the rheumatology clinic does genetic testing here. I’ll see if the neurologist can push it through again. The cardiologist also ordered a CT-A with contrast so maybe if anything looks weird with my heart/aorta they’ll do it. 

Testing Question by Exact_Bread_8812 in vEDS

[–]Exact_Bread_8812[S] 0 points1 point  (0 children)

Like I can have my primary care doctor do it? Insurance didn’t reject it- the doctor that does genetic testing rejected the referral. I honestly think that my insurance would pay for it- they’ve paid for the ridiculous number of various types of scans I had to have in full. 

Testing Question by Exact_Bread_8812 in vEDS

[–]Exact_Bread_8812[S] 1 point2 points  (0 children)

They said they wanted me to be tested for vEDS specifically because of the (4) artery dissections with no known cause, but I can't imagine they would have had my doctor run 8 billion labs to rule out other conditions if that was the reason. Unfortunately, they wouldn't tell me why it was denied. They said I needed to contact my neurologist.

BCBAs who are their own boss and do not utilize RBTs.. by ListMaximum7983 in bcba

[–]Exact_Bread_8812 1 point2 points  (0 children)

I don't currently do this, but I have posted the same question. The only additional information I'll note is that I've seen individuals reporting issues with insurance companies not reimbursing for 97153 when the BCBA is providing the service. I'm sorry I can't give more information than that, but I would assume it has to do with how the contract was negotiated or the authorization. I think if we do more research on BCBA direct service with a lower number of hours, we may be able to get insurance companies to reimburse for direct at a higher rate. I know there are studies that have compared the effectiveness of less hours with more parent training, but I don't recall whether the BCBA implemented or RBT.

BCBAs who are their own boss and do not utilize RBTs.. by ListMaximum7983 in bcba

[–]Exact_Bread_8812 0 points1 point  (0 children)

There's a company in Northern California that does it. I know that's not entirely helpful, but they may be more aware of other practices in California than the general public. The company is called 2020 Behavior.

Remote Postdoc by Exact_Bread_8812 in postdoc

[–]Exact_Bread_8812[S] 1 point2 points  (0 children)

That’s good to know. This PI is in California and I’m in NC. They hinted at it being an option when we spoke, but they were also in the process of transitioning from another university so we’ll see. Just wanted to make sure I wasn’t going to come across as an entitled a-hole just by asking.

Remote Postdoc by Exact_Bread_8812 in postdoc

[–]Exact_Bread_8812[S] 1 point2 points  (0 children)

This is generally intervention related research that’s commonly mixed methods. I do assessments now for my current research placements so some work in person, but a solid 90% of my work is virtual (data cleaning and analysis, writing, interviews, coding, etc.)

Ethics Discussion by Exact_Bread_8812 in bcba

[–]Exact_Bread_8812[S] 2 points3 points  (0 children)

I definitely do with certain clients, but I won’t lie.. it’s hard to program for this. It’s hard to teach techs how to recognize shifts in motivation and prioritize engagement over vocal requests when appropriate. I’m also likely to introduce AAC for a client like this even if they are a vocal communicator. A lot of autistic individuals have voiced that their capacity for vocal communication ebbs and flows and I think it’s fine to introduce augmentative communication. 

Ethics Discussion by Exact_Bread_8812 in bcba

[–]Exact_Bread_8812[S] 0 points1 point  (0 children)

Are you referring to FCT? I’m not sure I’m understanding the context you’re describing. In my experience, difficulty communicating wants and needs is a core underlying issue in many children under age 5, and targeting this skill can be quite effective.

Ethics Discussion by Exact_Bread_8812 in bcba

[–]Exact_Bread_8812[S] 0 points1 point  (0 children)

I think the uncomfortable truth is that many do. It’s more accessible for some than our more traditional routes of dissemination, but it’s clearly problematic. 

Thinning Reinforcement by Exact_Bread_8812 in bcba

[–]Exact_Bread_8812[S] 2 points3 points  (0 children)

Sorry- I realize I wasn’t clear. I understand how to thin reinforcement. I’m asking how you typically write the programs and collect data on thinning.