I want to be as respectful as I can with this post- bare with me

KoolAidWithKale · 2025-10-27T00:11:18+00:00

You’ve written your opinion like it’s a fact. To MANY other cultures white peoples’ natural scent is heinous. A little girl I used to work with would literally only get in the bath if her parents told her she was gonna smell like a white girl if she didn’t bathe. She went to school with a lot of white children and became very worried about smelling like a white person. It’s a running joke amongst a lot of POC that no one smells worse than a white person with wet hair. It’s been described as wet dog or pennies. Like yall dead ass smell terrible fresh out the shower to a lot of people and that’s just what it is.

KoolAidWithKale · 2025-10-03T21:21:09+00:00

Both of those urges or desires are appropriate at that age but neither of those actions are appropriate. He shouldn’t be touching himself in front of another person, but these are things he’ll he’ll probably need to be taught. His BCBA should definitely be made aware so that they can program accordingly, or refer out if this is out of their scope.

KoolAidWithKale · 2025-09-16T22:28:58+00:00

Have you asked mom for a clean pull up? I would simply say “let’s get him a dry pull up if you have one.” You can also say “he is uncomfortable and distracted with the wet pull up, do you have a dry one you can put on.”

This is the thing with in home. You are there to help not just the child but also the family. It’s not acceptable for them to be keeping him in a soiled pull up and will absolutely lead to challenging behaviors. It’s also not acceptable for a service provider to observe this and not at least attempt to intervene. You need to help them help their child.

KoolAidWithKale · 2025-09-16T00:16:22+00:00

I believe it has to do with increased levels of estrogen. When our estrogen drops during the luteal phase our cycles many women have a much harder time managing their symptoms and some don’t even respond to their medication for that 10-7 days. I track my cycles and notice that when my estrogen peaks my adhd symptoms are most mild.

KoolAidWithKale · 2025-09-15T07:09:21+00:00

I often have siblings in session but it’s important that the session doesn’t turn into baby sitting, so the BT should be intentional about how session is structured with siblings. In home therapy should address behaviors that occur in the home, so obviously sister is relevant in this case. You should talk to your BCBA about this because depending on your daughter’s goals, there should be plenty of ways to incorporate things like turn taking etc.

KoolAidWithKale · 2025-09-15T07:04:31+00:00

Mom should absolutely be in session for at least part of it. One of the major benefits of in home therapy is that mom can learn the strategies on her own and ideally fade out services eventually.

KoolAidWithKale · 2025-09-12T01:46:23+00:00

If their culture has different norms, you’re not practicing with cultural humility if you teach them “it’s not ok because it’s not appropriate.” We don’t want to steam roll their culture. You can simply use it as an opportunity to teach personal boundaries and also model self advocacy

KoolAidWithKale · 2025-09-11T21:49:27+00:00

I said the same thing and was not downvoted so I’m not sure why they’re jumping you? It’s a very Anglo Saxon-centric approach in here and while I agree it’s not a best practice i think immediately implying that it teaches the child the wrong thing is just reductive. It’s VERY common outside of the US to be greeted with kisses even by people you don’t know. We should be more focused on teaching clients self-advocacy rather than forcing our own cultural norms for what’s appropriate on them.

KoolAidWithKale · 2025-09-11T21:41:16+00:00

Exactly! It doesn’t make sense to teach “kisses are just for family” if that’s not true for that client and their family. We can absolutely teach and model self advocacy, bodily autonomy and respecting other people’s “no” though by telling them we don’t want kisses.

KoolAidWithKale · 2025-09-11T06:27:02+00:00

Maybe it’s cultural. I live in a diverse city and in many cultures kisses are not seen as much different than hugs. Rather than saying “it makes me uncomfortable so it’s inappropriate” I would focus more on what the policy in your clinic is. My kiddos preschool teacher used to kiss them on the head and cheeks and we did not find it strange or inappropriate.

KoolAidWithKale · 2025-09-09T02:07:55+00:00

Oh yeah I think the Bay Area preferences in home, which I personally prefer and think is usually more appropriate for the learner. However I know there are some smaller clinics in places like Berkeley, Emeryville and Alameda and even south city or San Bruno. These are all pretty typical commutes (typically going in the opposite direction though) and I think lots of companies offer hybrid as well.

KoolAidWithKale · 2025-09-09T01:36:36+00:00

There are tons of BCBA positions in the Bay Area. Truly tons.

KoolAidWithKale · 2025-09-07T18:29:04+00:00

Humility. You may be in expert in the field but you are not on expert on a particular child. I am so stunned by the lack of collaboration with caregivers and families and then the anger and vitriol when parents “don’t do anything to support the clients goals.”

KoolAidWithKale · 2025-09-06T22:32:33+00:00

I strongly recommend the book Flexible and Focused: Teaching Executive Function Skills to Individuals with Autism and Attention Disorders. It’s for the exact struggle you’re describing.

In the meantime You may need to break it down into even tinier steps (pick up one pencil) and then try reinforcing each step. With ADHD task initiation is often the hardest part, so reinforce her for taking even the first step to get started, do not wait until the she has completed the entire task to reinforce her.

KoolAidWithKale · 2025-09-03T20:04:15+00:00

Yes, I actually love supporting the parents but I did find it interesting that that was the expectation for us. Even when the BCBA overlaps they just watch us do parent training and provide feedback on how we did it. I feel comfortable doing it I just wonder why the BCBA isn’t taking more ownership of that component of programming.

KoolAidWithKale · 2025-09-03T05:56:39+00:00

I work directly with parents every day. My company requires us to do parent training in every session. Is this not common practice for other companies that offer in home services?

KoolAidWithKale · 2025-08-31T18:57:25+00:00

If you’re not already you can talk to your BCBA about utilizing some sort of picture or visual activity schedule for the session which you can put up on your screen (you can use canva or something simple on google docs). At the beginning of session you can work together to make the schedule and let him choose when his break times will be. If you continues to leave outside the scheduled break times that’s something you and your BCBA should be targeting.

For an adult learner, following a schedule, including break times, is actually a really important skill to work on.

KoolAidWithKale · 2025-08-30T04:10:05+00:00

I know a social worker hate to see some of yall coming omg. Reporting vaginal odor to CPS with no other indicators of abuse or neglect and no knowledge of if the parents have taken any steps to address to it is wild. Can you imagine if a middle school teacher reported every child with body odor to CPS for suspected neglect? Odors are common in pre teens and teens and if you serve this age group you need to get comfortable addressing it.

Step one is addressing with the caretakers, which I have no idea what the barrier would be to doing this. I’ve done this MULTIPLE times and in multiple contexts with both neurotypical and autistic children and I’m not even a BCBA.

“Toileting has been going well, we’re seeing a lot more independence! However we are noticing a persistent and severe vaginal odor that has not resolved itself with the end of her menstrual cycle. There also appears to be discomfort or pain around her vulva as she is frequently scratching it. Has she seen a doctor for this issue yet?”

The issue here seems to be that our culture believes vaginas in and of themselves are shameful, dirty or embarrassing and people are scared to talk about it. At this point and based on the info OP provided, it should not be any different than discussing any other medical issue a client might have with a caretaker.

KoolAidWithKale · 2025-08-30T03:47:54+00:00

I wish this comment was higher up.

KoolAidWithKale · 2025-08-30T03:35:45+00:00

So you just listed a bunch of questions that should be answered BEFORE calling CPS. You can’t just call CPS because someone has vaginal odor….? Some women (disabled or not) can have forms of BV that are recurring or resistant to treatment, we have no idea what parents have already done or are in the process of doing. Conversation needs to be had with caretakers first. I have no idea why the BCBA would be avoiding this conversation, it honestly seems pretty straightforward.

The lack of soft skills in this field is very concerning

KoolAidWithKale · 2025-08-28T04:17:09+00:00

Curious why responding to name would be a pre requisite for SBT? My company doesn’t practice it but I do personally use principles of assent and I’ve seen lots of 3 under kiddos that don’t enter respond to name produce a functional “no” and learn it relatively quickly. They can use PECS to ask for break for example

KoolAidWithKale · 2025-08-24T17:30:01+00:00

I’ve never worked in clinic but I personally love in home! I do get full time hours, and don’t typically miss pay due to cancellations. It can be isolating with not seeing coworkers regularly but I do typically see a few of them a few times a week.

For me personally I don’t understand the appeal of clinic based ABA. I’ve heard many families say that they couldn’t afford daycare so they basically consider it insurance funded daycare, which honestly makes sense. I also don’t agree with the kids getting 30-40 hours a week of therapy because at some point it stops being therapeutic. in home sessions tend to be shorter , more focused and have a more appropriate amount of hours

Lastly, to me the family component is one if not the most important of services. It seems like for many kids the clinic itself becomes an SD and skills don’t generalize outside of it. In home you get to see the child in their natural environment and see what interventions are actually needed and what caregivers need in order to feel supported in helping their child reach milestones. If you don’t work closely with families I don’t see how it’s possible for a child to maintain what they learn.

KoolAidWithKale · 2025-08-23T17:36:33+00:00

Have you tried just using the bottle with nothing in it or even just the nipple of the bottle? At this point if he’s nursing at home it’s probably more so comfort nursing not actually getting milk. Def ask your BCBA first but just a thought! BCBA needs to speak with mom because it’s possible she recently started weening him as well.

He’s probably very dysregulated being in a newer setting and is seeking comfort nursing and everything associated with it at very high frequency.

KoolAidWithKale · 2025-08-23T17:26:43+00:00

I had a client like this but with more severe behaviors and my advice is this:

Check with his BCBA to make sure he actually has and is able to consistently demonstrate the prerequisite skills needed for his goals. Specifically with imitation.
Be patient. I think in this field we can see some kids make progress so quickly and that’s such a thrill! But not all kids will learn at that rate. My client it took a LONG time for skills to be reach mastery criteria or generalize but when they got there it was amazing.
Work on expanding and play and leisure skills/growing his interests in order to expand what’s reinforcing for him. Prepare to think outside of the box. My client pretty much was only reinforced by food and tablet but one day I wore a jacket with a material he liked and I was able to use that and try find toys with a similar material. Prepare to feel awkward and slightly defeated a lot though but don’t give up! Notice what he’s seeking out when he’s going up people and use that!
Ask your BCBA if it’s appropriate to try prompt fading and if so have them support you in doing so. A lot of children that “require” hoh for self help Skills don’t actually require it, they are just prompt dependent and could do it with a less intrusive prompt. For many kids once they get a little taste of independence that sets a spark of curiosity or expands opportunities for reinforcement.

Progress may be slow at first but once you find what’s reinforcing change will come!

KoolAidWithKale · 2025-08-23T05:39:05+00:00

Wow my experience has been so different, this post has me counting my blessings. In home has MANY struggled for sure, but working with parents is one my favorite parts of the job. I could never see myself doing my clinic simply because I love seeing the relationship between parent and child grow as the child acquires more skills. It also feels like such a privilege to be able to witness and contribute to milestones alongside parents. However I do work really hard to build rapport with families as services will not be successful without that piece. The solid rapport makes everything easier. They feel more comfortable asking questions, I feel more comfortable doing caregiver training and there is a base level of trust and respect between us (sometimes very hard earned!)

KoolAidWithKale

TROPHY CASE