Dually Certified SLP/BCBAs on Collaboration with Parents and Other Providers | Panel Interview

Transcript for Podcast Episode: 118
Dually Certified SLP/BCBAs on Collaboration with Parents
and Other Providers | Panel Interview
Hosted by: Dr. Mary Barbera

Mary: You're listening to the Turn Autism Around podcast episode number one hundred and eighteen. Today, I have three guests on a panel. We are doing an SLP BCBA panel with Kate Grandbois, Liz Willis, and Rose Griffin. And we are talking all about collaboration between speech and language pathologists, parents, behavior analysts, and all other professionals. And it's a great conversation. You'll want to stick around before we get to that. And they are going to introduce themselves, tell you all about where they're at and all three of them have podcasts and are interested in dissemination. So we're going to get to that in just a second. Before we do that, this is airing the first Tuesday in April. My book, Turn Autism Around and Action Guide for Parents of Young Children with Early Signs of Autism is now out. It already reached number one bestselling new release in five different Amazon categories. So you're going to want to check that out, whether you're a parent or professional.

Mary: And Temple Grandin wrote the foreword, her podcast episode aired last week. So you want to check that out as well. OK, before we get to the interview, Rose Griffin, one of our panelists today. She's been an SLP for almost 20 years and a BCBA for a bunch of years as well. She read the draft of my new book. She also took my online courses. And we are great friends and she's doing great things at ABASpeech.org, she wrote a nice blurb that's in the front of the book. So I'm just going to read it quick for those of you who haven't gotten the book yet. So she said. Rose says "Turn Autism Around is a detailed book that provides parents with actionable steps that will allow their children to learn and thrive. Mary empowers parents to be the captain of the ship on their child's journey to increase communication skills and happiness". And that is Rose Griffin S.L.P, BCBA, owner of ABA Speech.

Mary: So Rose is one of our panelists. She's also on a previous podcast as well. So let's get to this important panel discussion where we talk about language, waiting lists, AACs and collaboration between parents and professionals.

Mary: OK, so thanks so much for joining me, everybody, on this panel. It's been great to kind of put this together. And thank you for your time being here. So we are going to start with briefly describing your fall into the autism world. So why don't we have Rose, you go first.

Rose: Absolutely. I started working with students with autism in my graduate coursework, and I really just loved it so much that I have really dedicated my whole career to working with students with autism. That is really kind of my mission statement. And what I am passionate about is helping students who are not able to communicate, find your voice. And so I have done that as being a speech therapist for 20 years and being duly certified as a BCBA for 10 of those years. And so that is really was my fall into the autism world.

Mary: OK, and Rose has her own podcast, but she also was on episode number 10 with me here on my podcast on the Turn Autism Around podcast. So we'll link that whole episode with Rose in the show notes. So if you want to learn more about Rose, that's a great podcast and one of my favorites. OK, Liz Willis it's why don't we go next to you. How did you get into the autism world?

Liz: Sure. A similar fall as Rose, I would say. I actually when I was going to be a speech therapist in grad school, thought I might go the medical route, but had a school placement and worked with kids with autism and just kind of fell in love. So I've been a speech therapist for about a little over 10 years and a BCBA for maybe about five. And a lot of my caseload, a lot of my clients are individuals with autism and I just really love working closely with the families and providing more of a coaching and play based approach with my kids with autism, and then also do a lot of training and consultation of speech therapists, teachers and then other staff that work with kids with autism as well.

Mary: Great. OK, Kate, Grandbois, right? Is that the pronunciation? OK, good job. All right, cool. All right, let us hear your fall into the autism. Sure.

Kate: So I got started or fell into the autism world when after graduating from undergrad, I got a job as the data manager for a sibling study through Johns Hopkins School of Medicine and was there for a few years. And everyone I worked with was a speech pathologist. And so I fell in love with the field, went to graduate school, later, went on to get my BCB. And I have been involved in the autism community ever since.

Mary: Wow. And one of the things I noticed, Liz, is from New Jersey, Rose is from Ohio and Kate is in Massachusetts and I'm in Pennsylvania. So we're all in the northeast corridor here in the United States. But you all started out as SLPs, speech and language pathologist and you added board certified behavior analyst to your title and to your work. So why did you do that? And I know, Rose, you've been an SLP for a very long time, like years. Is that almost 20 now? But oh, boy, yes, she isn't.

Rose: I call myself seasoned. I'm not old.

Mary: OK, so. And then so why did you add your BCBA or feel the need to add your BCBA?

Rose: So my second year as a speech therapist, I started working in a nonpublic program for students with autism. And so it was for students who had behavioral barriers to their learning. And that was the first time I ever learned about the science of applied behavior analysis. And I was had so many aha moments of working with students who were advanced in chronological age but had absolutely no way to communicate. And we were able to help those students start communicating even at 18 years of age. And that may be so sad to see students that were that old, that didn't have a way to communicate. And I remember learning about ABA Mary and I remember thinking and I said it way back in the day, like, I want to go places and I want to talk to people about the science of ABA because I had seen it literally change people's lives and I was completely hooked. So I was like, I want to learn everything that I can about ABA and I want to now in the platform that I have at a speech, I want to be able to share that with parents, professionals so that they can help others as well.

Mary: Yeah, OK, so, Kate, how long have you been an SLP and why did you add your BCBA?

Kate: I've been an SLP for going on 12 years, I think, and I've been a BCBA for about five. And I had always known and been interested about or in applied behavior analysis. But about seven years ago, I was in private practice, working by myself in an office, and I realized I had also employed as a quote, AAC specialist. So my client population has always been individual non-speaking individuals with behavioral needs. And I realized while I was working in private practice by myself that I could teach you to I can teach you to communicate, but I'm not going to be a very good therapist if I can't get you out from under my table or if I can't really facilitate more or remove some of those barriers for learning. So I realized that for the group of individuals that I really wanted to work with, I had to improve my scope of competence with behavior management.

Mary: Right, right. And we're going to talk about AAC. You want to just define that for our audience members who don't know what AAC is?

Kate: Sure. So augmentative alternative communication is a system of supports that an individual who has limited speech or is non-speaking might use to augment their communication or improve their communication or use as an alternative to natural speech. It's a whole field.

Mary: Yeah. So we're going to get into that in a minute. But you said you are an AAC specialist, so I just wanted to kind of tell the audience because we have quite a few parents here as well as professionals, and I don't want them to feel like what is AAC? But we are going to dive into a little bit more in a minute. OK, so Liz, you said you've been SLP how many years?

Liz: About 10 years and a BCBA about five. I'm starting to lose track. Yeah, yeah. When I was fresh out of grad school, as I mentioned, I worked in some several autism support classrooms and I really was just fortunate enough to be provided consultation through the Pennsylvania Autism Initiative. So I think I don't know Mary I think you're familiar with them, but.

Mary: So but you were in Pennsylvania?

Liz: I was in New Jersey. So, yeah, I actually work for an organization in Pennsylvania, Chester County Intermediate Unit, so I continue to work for them today. But that was prior to starting to work for them. But I had consultation through the Pennsylvania Autism Initiative and I felt like they were filling in so many gaps in in kind of what I needed to know to effectively program for these kiddos. And I just learned so much from them within a couple of years and decided to then go ahead and pursue my BCBA.

Mary: Oh, interesting. Yeah. So I was the lead behavior analyst for what was called then the Pennsylvania Verbal Behavior Project, which is now the Pennsylvania Autism ABA Initiative back in 2003-2010. And so we actually I say home grew some BCBAs, some SLPs like you are Liz. Parents who became the BCBAs and consultants with the project. And it was a huge learning experience. And so yeah, it was, it still is going strong as an initiative and they are in hundreds of classrooms. Autism classrooms throughout the state of Pennsylvania. It's a really good model. And other states have also gone to the Pennsylvania Autism Initiative to learn how it was implemented from back in 2010 to yeah, it's almost at the 20-year mark. And I was involved with almost at the beginning when we had well, they went from two classrooms to 12 classrooms and I was contracted and it was I mean, it was ground zero for all of my learning. So, yeah, I didn't know that you were in Pennsylvania doing that and you may have missed me. I did leave the Verbal Behavior Project in 2010, finished up my PhD and began working with very little kids. And that's really where I developed my four step Turn Autism Around approach for very young children with the diagnosis of autism and also those with just speech delays and early signs of autism and ADHD and those sorts of things. So, yeah. So that's really great to hear that our paths kind of crossed in that.

Liz: I knew your name right when I started in consultation with them, so I've been following along for a while.

Mary: Yeah, so that's great. OK, so now there are according to Nikki Dower, she's in SLP/BCBA and she has taken it upon herself to really embrace this dual certification and keep track of it. And she has messaged me and I asked her how many dually certified BCBA/SLPs. I guess you usually go with SLP/BCBA because that's how most of you start. It's a lot harder, I think, to add the SLP to an existing BCBA than it is to do it the other way around. And she said there's four hundred and thirty of you within forty, forty or forty-four states and 12 countries. And you also call yourself Unicorn's, because it is a very unique combination. And I just happened to have three of you here today. But and I feel like it may be actually the key to helping everybody get along better and work towards improving things, bridging the gap. What are some of the obstacles or some of the kind of problems that BCBA, if you're just a BCBA or just an SLP that you guys have seen over the years?

Rose: I think one of the things that just seems so simplistic are the jargon type terms that both sides used. And so I when I first started ABA Speech with this online dissemination, I was speaking in very technical terms to an audience. And I think that's a little off-putting. And I know that I've been in meetings before. I heard people use terms like ASR, active student responding, but they just said, ASR I have no idea what that was at first. Even LMBCBA and I use that term I used in a presentation last night. You have to know your audience. And I think that when a BCBA traditionally comes on the scene for a school-based team, it's because things are going not well. Things are in a crisis mode. And so then here we are talking about how we're doing things and maybe we're doing things in a similar way. That could be possible. But BCBAs are notorious for using jargon type terms like manding and tacting and echoics. And speech therapists just don't use those words.

Rose: We may say verbal imitation and requesting and so that on a very surface level kind of sets the tone. And so I've tried to use my platform to build a bridge. I always say between SLPs and BCBAs because sometimes a speech therapist will meet one BCB a potentially in a meeting or they're consulting in their district or something of that nature and they have a bad experience. And then they think that every single BCBA is maybe not very friendly and things like that. So I'm trying to turn the narrative on that. And I want people to see me along with my fellow unicorn's that are trying to disseminate online and say, like, OK, yeah, I do that in therapy. And so I think it's just those simplistic type things that seem so easy for us to just remedy on both sides. And I talk about that a lot. I teach an ethics course here at Kent State for people becoming BCBAs.

Rose: And I specifically put a lot of information about collaboration and using jargon because using jargon is against the code of ethics for BCBAs. But we do it and we do it without even thinking. So I think that is just a starting point, is just to talk in simple terms. It doesn't mean that you're less scientific if you do that. And I think that's what's so great to me. About your book and about the message that you bring to parents and professionals is we can call these things what we're doing them. We don't have to always refer to it in a specific way using jargon like terms, unless we're talking to a room of BCBAs. That's something I think that we can do better with.

Mary: And even if we are talking to a room full of BCBAs, it's like they we can't talk up here with our jargon. And, you know, I remember people are like, well, what's the difference between motivation, motivated operations and discriminative stimulus? It's like I would have a hard time personally answering that question today because I have spent the last two decades trying to translate it into easy activities like my shoe box program. You don't have to know what a mand a tact, an echoic is. I guess I'm putting it all together in an easy thing and easy practice that if you're a parent or your new SLP or new BCBA, it doesn't matter. And I think I totally agree with what you're saying. I totally agree. And I think we all need to not use lingo as much and abbreviations, because the main goal is that the parent understands it and can help the child. And I think that's an excellent barrier that we face with only four hundred and thirty of our SLP BCBA is around. OK, what other kind of obstacles and barriers do we have between the two fields? Go ahead, Kate.

Kate: You know, it's such a loaded question and there's so many, it's such an important question, in addition to everything that Rosie identified, I think there's also a lot of misinformation out there about what ABA is. So I for I'll use myself as an example. Before I became a BCBA. I was working in an outpatient clinic in a hospital. One of my patients communicated with a high-tech communication device. He was receiving ABA services at home. And the parent told me that they were using a, quote, verbal behavior approach. So as a new grad, I asked my supervisor, what's that? And she told me that it was when they took his device away and made him speak. I spent many years being very frustrated with verbal behavior. And I think that that level of misinformation happens today. I see other speech pathologist posting online about, you know, don't listen to the BCBA. We don't modify behavior. We use sticker charts.

Kate: And I'm thinking, oh, my goodness, that is ABA. You just don't understand the full, you don't see the forest through the trees and really understand that it's a science and a framework. And I think that combined with some of these prickly interactions that we may have as collaborators, my colleague calls it emotional food poisoning. So if you have a really not so great interaction with someone that you're trying to collaborate with, it's sort of spoils the pot for all future interactions. So when you take those two components, combined with this jargon that no one understands sometimes, unfortunately, that is no longer a barrier. It's a wall which doesn't do anything but, you know, create issues for progress for the client or student and the family.

Mary: Yeah, wow, that's really good. I like that emotional food poisoning. Well, I don't like it. And I also when you said they're using a verbal behavior approach, when anybody tells me that as the author of the verbal behavior approach in two thousand seven, I'm like, oh, what do they mean? Because, you know, about verbal behavior, it can look really, as Liz knows, being a part of the verbal behavior project in the autism initiative, I go into classrooms and especially in the beginning of my consultation, I worked with some classrooms for years helping them. But in the beginning it's like, oh, you know, they're worried about man's attacks and this child is pulling hair and won't sit on the toilet. And it's like, I don't care how many intervertebral he has. Like, we need to put priorities first. And yeah. And I like what Rose said about when SLPs do consults or school districts do consult with ABA. It's usually a very severe situation where, you know, once a child starts banging their head and starts really aggression and everything, it's hard to turn that around. And it's hard to, it's not a win win situation.

Mary: So we need to spend ninety five percent of our time on prevention. And I also found in the early intervention world, it was hard to go into. This child has one hour of OT, one hour speech, one hour teacher time. And I go in as a BCBA and as was like a kind of a trial contract thing. Like usually early intervention doesn't include BCBAs who know anything about ABA, but it's like we don't have months to do it your way, you know, do feeding with an occupational therapist who's putting a bowl of applesauce. Oh, the child cries. OK, taking the bowl of applesauce back. It's like that kind of feeding intervention or playing with pasta. Like that's not going to work. And I had Dr. Keith Williams, international feeding expert on episode number ninety-five. It was excellent. I learned a lot from that. And I have a chapter on feeding in my book. But, you know, just coordinating not just with SLPs and BCBAs, now we have the teachers, the occupational therapists and the parents, physical therapists, the paraprofessionals and the school bus drivers and the cafeteria aides. So we are like just scratching the surface here. So I think those are excellent points. Liz, do you have anything else to add or is it?

Liz: Yeah, I mean, I actually spoke about this at a presentation for the ABA forum just this past week about just recognizing that as SLPs and BCBAs we have overlapping scopes of practice and a lot of our focus is working on communication. And I think it's important for any professional to recognize that we maybe may have overlapping, overlapping scopes of practice, but not necessarily overlapping scopes of competence. So I think a lot of times behavioral analysts are trying to work on things like speech and vocal programing. And one of the points I made is that speech is a behavior. But just because speeches that behavior doesn't mean that it's something that a behavior analyst should be working on solely. It should be really part of the team and really seeking out consultation and collaboration with a speech therapist in order to target those skills. And I think my one tip in terms of collaboration is to reach out right away and initiate that communication right from the start. I think oftentimes we're not communicating unless we're disagreeing about something or unless something pops up and we're like, oh, they're working on this or oh, the student has it has a device now. But right at the outset of the relationship, open those lines of communication and let that other professional know that that you're part of the team and that you value their opinion and that we want to work collaboratively.

Mary: Yeah, I think that's a great, great point about having overlapping scopes of practice. And I have, even as the author of the verbal behavior approach been received, some feedback like, you know, she's not an how dare she give kind of verbal advice, information. And I am not skilled at many things like AAC, which we're going to talk about in a minute. I'm not a skilled provider of that. I'm not skilled in many areas. I'm not skilled at hearing the sound. What it sounds like A or Ah. Or like all of those things that SLPs are really trained up, I'm not skilled at tongue ties and things like that, which SLPs don't just focus on the mand, the tact. They also work and do clinical rotations and work with patients with strokes and swallowing and feeding and all kinds of things that are intense and uncomplicated. As a registered nurse, you have to go through clinical training. So for those of you that are here and it seems like the SLP BCBA unicorns, if you will, are very much in seems to me to be in the autism field. Would you agree with that?

Rose: I don't know. I mean, I know all the ones I feel like a lot are, but I'm not certain of that. But what you were saying, I think about speech therapists, even some BCBAs that I work with when I was becoming a BCBA, I remember hearing because I was a consultant down in Texas for this thirty-five school district. I love that job. And I remember one of the BCBAs kind of saying, well, gosh, I can't believe the speech therapist didn't know X, Y, Z. And I was like, well, do you know that in graduate school, speech therapists learn all about how to help people after strokes and when they have swallowing problems. And you don't know what an SLPs journey has been, even if you're a parent listening and maybe you're working in your child is in a school district and it doesn't mean that a speech therapist doesn't want to once they know better, they'll do better. It just means that every single speech therapist is going to have a different journey until the time that they're working with a student with autism. I mean, we all here today are passionate about helping people with autism. And that's why I became a BCBA, because I wanted to help as much as I could. But that's just not always the case everywhere. And so we really have to be cognizant that speech therapy is a lot more than just helping students with autism. That's what we choose to specialize in and that's what we're passionate about. But not everybody has that same experience.

Mary: So and the waiting lists for SLP, you know, a lot of hospitals, you can't get in the waiting list for evaluations for autism with developmental pediatricians and neurologists are months, if not years long. The waiting lists for Sleepy's are equally as long. And my new book, Turn Autism Around. Really, I want to empower parents to detect and treat the earliest signs of autism and other delays and really try to get their child talking and imitating and playing and eating better and sleeping better potty training and all of these things. And I know some families around the world are really struggling to find any professional help. I know one guy. He was on my podcast listener survey panel, and he basically he in another country, I forget where he was south of South America, I think. And he said, I have a two-year-old and I have money for either one hour of speech or one hour of ABA. What should I do a week? Yeah, there's nobody. And I have money for one or the other.

Mary: And I'm like, I would do neither. I would actually learn yourself what to do because one hour of speech is like a drop in the bucket and it's some speech therapists. Another thing I'm kind of get on a high horse about is some speech therapy centers and hospitals or whatever is their quote unquote policy that the parent be in the waiting room and they take their child back and do some magic with them. And some magic doesn't look very good when the child is screaming on the way to the therapy room. So I am like parents are driving an hour each way, paying co-pays for us helps and then not being a part of it. And so maybe the discussion shouldn't even be about how to bridge the gap between SLP and BCBAs, but like how to have the real focus be on the parent, especially in the early intervention world. What are your thoughts? Any additional thoughts? I know I kind of got on a soapbox.

Liz: I have I have thoughts on that. I think actually at the time we're in right now with covid and a lot of services transitioning to the virtual environment. It's really eye-opening to see how, you know, how now we were getting the opportunity to really interact with parents a lot more and doing a little bit more of that coaching approach. How that was really lacking, I think in a lot of professions and in education in general, that support of the parents, in that training, in that coaching. So I. I think it's a really good take away from kind of us being forced into this virtual learning environment to then kind of reflect and go back if and when things do go back to normal. As professionals, we really need to be involving parents and caregivers more in our in our treatment.

Mary: Yeah. In fact, I just read New York Times article today that we can link in the show notes, but it's all about kids at home during the pandemic, little kids showing signs of autism, trying to evaluate kids with autism. And one of the I mean, the whole article is excellent. But one of the things it said was, you know, many of these kids with delays and early signs of autism have spent half their life in isolation with only contact with their parents, no social contact, no preschool teachers looking at them, no real doctors looking at them. And I mean, I know how important all of our information is because especially during covid and it's just one of my online participants, Michelle, she's featured in podcast seventy-eight, which we can link in the show notes. She got the diagnosis at twenty-four months for her daughter and then she wanted to get ABA and the world closed down and she was caught with a two-year-old and a newborn at home by herself. And she found my online course and she made miraculous progress in in a month. And so she talks about that in the podcast episode. But she also had, this is another area which we could do a whole podcast on. She also had speech and language evaluations both a month before the diagnosis and right after she did my online course, which show major growth from zero to three-month baseline to thirty month on expressive language. And so actually, my mentor, Rick Cabina and I have written that up as a case study. Hopefully it will get published.

Mary: But, you know, that's another confusing thing, is all these speech therapy, standardized evaluations and if you can get them, great. But when a parent sees, OK, they have a two-year-old and they're functioning at a zero-to-three-month level on the Rosetti infant toddler score as basal score, or they're functioning even as a two-year-old functioning at a 12-month level and that sort of thing, expressive, receptive. It freaks people out. And really, it's like this is an emergency, maybe especially if you have somebody with that, those kinds of delays. So I just think and then after the fact, she got a whole set of different evaluation, speech evaluations. So it does seem like. The standardized autism ABA screen or just autism screeners are. I don't know, it's like all these speech evals, like I know they're all standardized, but like if all parents are getting all these different things pre and post, like, how are we really telling what's working?

Kate: Well, I think it up in our field, we have a cultural reliance on standardized measures and one of the episodes in our podcast, we reviewed some of that literature. And the fact is that the norm referenced assessments we use are bias. They're good for measuring a child's or individual's ability to a standard of norms. And it might tell us what a child knows, but it doesn't tell us how they learn. And that's sometimes one of the most critical pieces. And there are a lot of other assessment types that speech pathologists can use to get a better measurement, because that's the whole point of assessment, right, is to measure exactly what we need, you know, to really support that student or child to move forward. And I would encourage anyone listening, professional or parent, to make sure that there are different kinds of assessments that are considered criterion referenced assessments or dynamic assessments to make sure that evaluations are an accurate representation not only of what a child knows, but how they how they are learning.

Mary: Yeah. And in my book and in my courses, I talk about I encourage parents on baseline to set a timer and actually do a language sample too, so that they can say, OK, my child had two words in one hour or two words in 15 minutes, and then do your intervention and see if it works. Because, you know, we're all we're kind of preaching to the choir, not just the panel, but everybody listening believes in ABA. But like some people say, well, I don't believe in ABA, but it's like if you whatever a parent is doing, if they're going from two words to five hundred words or, you know, going from no imitation to imitation, if I go in and I hear that, I'm like, I'm going to be curious, what are you doing? Show me. And I think this is where we can have a lot of collaboration, because it's not just the magic of a one-hour sleep session. It really does need to be a lot of partnership.

Rose: I think that's the most. And part of having to marry is just said as a speech therapist, I think all of us would say the most important part of our jobs almost is making sure that we have that shared and ongoing communication. Just like Liz said, that I always let parents know even when I'm working in a school, that you're an important part of the team. I want to know, what are your concerns like way prior to the IEP meeting? Those are things that any good speech therapist should be doing, is making sure that that parent feels heard. I think oftentimes parents are unsure. And I think that's what your all of your things do, is make parents feel educated and make parents feel savvy about what should this look like? How can I help? And I think my most important job as a speech therapist is to make sure that all those different people you mentioned, care professionals, parents outside, speech therapist, school speech therapist, that we're all on the same page because if we're not all on the same page and it doesn't mean that we're all thinking the same thing about how to help the child, it's just that we're working towards that common goal.

Rose: Because if we don't have that in mind, you're right, we're isolated. Like I always say, the best thing that happens is what's happens outside of the speech therapy rooms. I always say it doesn't stay. The magic doesn't happen back into speech therapy room. The magic and the most important part of my job is that I know that my student gets outside speech and I talk to that speech therapist. I know that my student has outside for and I talk to that person and that we make sure that we have this cohesive, ongoing communication, because if we operate in these silos like a lot of the times that we do, because that's just kind of the norm, you know, then what are we really doing? Like what is the student really learning? Right. Because they're not learning much. Sometimes that can be the case.

Kate: And to piggyback onto that, just as a reminder, our evidence-based practice triangle or definition through the American Speech and Hearing Association is one third of that is client and family values and perspectives. So including family values and perspectives and making sure that everyone is on the same page and considered as heard is evidence based practice. And I think that that is often accidentally left off the table because it's an article or it's a treatment approach that someone is recommending and that's the evidence. But parent, client, family perspective and values is a critical component of that.

Mary: Yeah, I have a whole chapter on planning and making sure your goals are right for parents to learn. Because Lucas had some goals with speech therapy when he was to some of the goals were manding and that sort of thing, but he also had goals in there for basically, yes, no tacts and some versus one versus all, which were way too hard. He didn't get those skills for years, years later, until years later. So I really want to empower parents to look at the assessment language sample and then look at plan, including, like you said, Kate, their values. You know, for one of my families, they were from a culture that really valued like sleeping with our kids, the family bed, even though the child was six or seven. So to them, they didn't really want, you know, those sorts of interventions to help him sleep in his own bed at that point anyway. So we really have to pull in those values. And one final thing I'll say about that is, is I always I heard something once. It's like especially working with the Pennsylvania Verbal Behavior Project with all these individuals is like, leave your ego at the door.

Mary: You don't have to have the answer. You just need to collaborate. And it's not about, oh, it was my idea. It's like, no, we're here to help the kids get as better as they can, as fast as possible. And so we need to really work with people, which I think is I mean, your messages here are so clear that that's your goal. All right, let's switch, because I said we were going to talk about AAC and I really want to talk about that. And I know, Kate, you're you consider that one of your areas of expertise. So AAC is important in an important discussion in the field of autism, and it can involve sign language, picture exchange, iPads, talking, learning to write and spell and all kinds of things. And it can and should be used for kids who are not speaking. And so but there also is confusion when I say that is there's a thing called facilitated communication, which also involves typing and learning letters. And that is it. Maybe you can describe it. Why don't we talk about facilitated communication and then we'll talk about AAC and how that's different, because I think there is some confusion.

Kate: So I'll start I'll tackle that by starting a beginning with what augmentative alternative communication is. OK. So as I mentioned before, AAC is a system of supports that are either used just with your hands, like you said, sign language, or it's used with something external to your body, like a pen and paper or an iPad or a picture supports or communication book. And it's used to either augment as an improve an individual's communication if they have speech. But their speech is not their natural speech is not meeting their communication needs or in place of speech. So if an individual is nonspeaking, these external supports or supports unaided supports at such a sign language can be used to replace natural speech when you're talking.

Mary: Let me let me just jump in here. So and AAC is also used for patients with strokes or head injuries or if you're intubated and have a toothache, you can't speak. So this isn't just about autism, but it is a way to help people when they can't speak yet or ever how to augment or give an alternative so that they can't communicate.

Kate: Exactly. So this is a very large it's a big area of study across the lifespan and a variety of different diagnoses. And obviously, it is a topic within the community, the autism community. The goal of augmentative alternative communication is to help someone find their independent voice. So the little cute acronym that we use a lot is snug. You want their communication to be spontaneous novel. They want spontaneous novel utterance generation. And it is very much rooted in the Communication Bill of Rights, which you can Google if you want to look it up. So making sure that people have an independent means of making their wants and needs known, communicating about preferences, social contact, gaining access to information and everything as specific as pain and medical needs. I think when you start talking about comparing AAC to facilitated communication, the real difference. Is that independent and spontaneous utterance generation, so that is a fundamental tenet of AAC, whereas facilitated communication they've shown over a period of studies is not rooted in an individual making independent utterances.

Kate: So to explain that best, I'm going to get my time machine and do a very brief little history lesson on what facilitated communication is so facilitated communication, I believe, emerged in the early nineties. But don't quote me, I don't have a reference for that. And it became very popular because people were reporting that they're individuals not necessarily with autism, but individuals without natural speech or without functioning natural speech, where all of a sudden able to communicate through this procedure where an individual would hold their hand and help them type on a keyboard. And these were stories where individuals who had very little communication were then typing poetry and explaining all these things through a series of court cases. Actually, it came to it was ordered it was I believe it was ordered by a judge to do some studies on whether or not individuals who were typing or typing their thoughts or typing the thoughts of the person who was holding their arm and helping them type.

Kate: In the late nineties I'm pretty sure the research was spearheaded by Howard Shane, who's here in Boston. They discovered through a series of studies that the individual who was typing was not typing their own thoughts. They were typing the facilitator, the individual sitting next to them, holding their arm, was doing the typing for them. So this is an instance where not only was the person, the communicator not able to communicate their own needs, they were having they were being forced to communicate the thoughts of someone else, which is, as I'm describing it, sounds pretty unethical. Right. Fast forward to today about I think last year or two years ago, the American Speech and Hearing Association did come out with a position statement strongly against the use of facilitated communication. There have been other position statements through other organizations, including the International Society for Augmentative Alternative Communication, or ISAAC, stating that this is really not a practice that should be practiced because it does not honor an individual's autonomy or their access to their communication bill of Rights.

Kate: So to sum that up, facilitated communication is not augmentative alternative communication. It is not something that, as speech pathologist we support. It is still done today and I encourage anyone who is interacting with facilitated communication is has been sort of rebranded, I believe, under a different name called supportive typing. That's also a no no. In terms of the speech pathologist community, that's not my opinion. And if you are interacting with it or you see it, I would encourage some deep questioning as to the levels of autonomy and respect for the individual who is needing that assistance.

Mary: Yeah, and I, I think as a parent, I often wonder, you know, well, if you're going to teach a child, say, to type, there is going to have to be probably some prompting or even selecting, you know, the chip icon from a from a iPad or whatever. I mean, is it just seems like. Well, so how do you use AAC? I mean, you're going to have to have some prompting or some systematic instruction, and that would have to be an AAC specialist who is also an SLP. So now we're not only looking for an SLP, now we're looking for an LP with SAC, with autism experience, with behavioral experience. It just sounds like boy. We're really looking for a needle in a haystack now. Right.

Kate: Right. So to sort of answer your question, successful AAC is usually not just the tool that you choose, but it's also how it's implemented. So it's the teaching procedures and teaching someone to communicate the different teaching procedures are always very unique to the learner because no learner is the same. Right. And there's a variety of different things that we do besides hand over hand prompting. So hand over hand prompting in AAC is generally frowned upon, I will say, because it mimics facilitated communication and removes that individual's autonomy. If you are doing it to a speaking person, it's sort of like forcing taking your hand on their job and making them speak. Right. That's nobody would do that. And you want people who are not speaking or minimally speaking, to have the same rights as a person who is capable of successful natural verbal speech.

Kate: So in terms of finding the needle in the haystack, this is also another big discussion in our community, because it shouldn't be hard it shouldn't be hard to gain access to this knowledge or gain access to an individual who has this knowledge. And it's a big problem in the field. It is within the scope of practice of speech and language pathologist. It is not necessarily in their scope of competence. And I know that there is a lot of conversation at the state level in different states across the country about making AAC knowledge available to teachers and speech pathologist through required trainings. In terms of any parents who are listening or even other professionals who want to learn more about AAC, I definitely encourage people to seek their own learning journey and learn about some of these different strategies, everything from how a tool is chosen to different ways to make it successful. Because you're right. It shouldn't be finding a needle in a haystack.

Mary: Yeah. And I also want to just add that people ask me all the time, well, will sign language impede vocal language, will pictures will. And my answer is the research shows that any augmentative additional techniques like sign or picture will not will actually improve their ability to vocal vocally speak. As long as you're pairing the words and as long as the child is not crying or that sort of thing, because if they're so aversive to whatever you're doing, you're probably not doing it correctly. And a child who's crying is not learning much at all. So that's kind of my I think I touch on I see a tad in my new book. I touch on it a little bit in my verbal behavior approach book. But my goal really is, is to help parents of very little kids get them. If they're talking like Lucas was talking, he had some pop out words, getting them to speak more and getting them to find professionals who can help them systematically increase the length of utterance, increase their comprehension.

Mary: I have some specific things that I don't like to focus on early on, and it's all outlined in my book. But I do think that parents need to know that augmentative communication is not going to hurt the situation and they oftentimes will help. Agreed. OK, cool. All right. So we are getting to the end of our podcast episode, and I know all three of you have podcasts and are all about disseminating more than just one to one. You want to go one to many and really get the word out. You're all very qualified professionals who have such a unique gift of having both A and are interested in dissemination like I am. So why don't you briefly go through it and just tell our listeners where they can find you, what you are doing to disseminate the name of your podcast, and we can put those in the show notes as well. So why don't we start with you, Liz?

Liz: So, yeah, so I hang out most of the time on Instagram. My Instagram account is Let's Talk Play. I'm big into teaching play and teaching free play so you can find me there. I'm always interested in messaging back and forth with people and questions. That's generally where to find me. I also have a podcast with my sister, who is a literacy specialist called the Language Literacy and Play Collectives. So we talk about all things related to those three topics. I'm going to come out with a course in the next month or so. So we're launching our website. Some exciting things happening there. So, yeah, and you can find me also via email, Liz@CommunicationandBehaviorSolutions. Communication Behavior Solutions as my private practice.

Mary: OK, great. OK, Rose.

Rose: Visit me at ABASpeech.org. We have courses, we have some free webinars that are coming out in the beginning of April, all about how to help students with autism engage and communicate. And we also have a podcast called Autism Outreach, which I really love. It's all about communication and autism. And actually, I've been inspired, Mary, by your membership because I do some parent consultations for people wanting that in your membership. And so I am going to be launching in the next month or so of therapy services from myself and other aides and speech therapists that are very skilled in using applied behavior analysis. And we're going to be covering about 10 states and potentially a broad based on the country that you live in and our licensure. So make sure to look out for that at a speech dog.

Mary: Cool. All right. And Kate.

Kate: I have a private practice here in Massachusetts that specializes in augmentative alternative communication and consulting. And then I run a continuing education company called SLP Nerd Cast. That is a podcast. And you can visit us there at SLPNerdcast.com or email me any time at [email protected].

Mary: OK, well, you guys better get ready for a lot of emails and a lot of visits because we do have many, many parents and professionals from around the world who listen and are interested in learning more. OK, so to wrap it up, part of my podcast goals are for parents and professionals to be less stressed and lead happier lives. So do you have any final stress management tips or self-care tips that you do?

Rose: I think the thing that's so important about self-care is that no matter what you choose, I've been choosing tick tock and silly things like that since the pandemic started. And that's kind of a guilty pleasure. We have a family account, but I'm also doing it for my businesses, too. I think whatever you choose to do that you find relaxing for you that allows you to debrief, especially as being a mom to is to just to take that time and to try not to feel guilty about taking that time that you really do need. My time allotment might be different than yours, but we really do need that time to do whatever we deem fun in motivating and not feel guilty about it. I would say just sometimes you need to schedule that. You need to like look at the week ahead and put it on the schedule to make sure you're getting in that self-care time and process. Self-care isn't always the same for everybody. It's not like necessarily bubble bath. Some candles find something that's unique to you that that you can kind of decompress and regroup, but make sure it happens, get it on the schedule.

Kate: I second to all of us sentiments, about a year ago, I found ACT, Acceptance Commitment Therapy, which is rooted in applied behavior analysis. They have a book that I purchased, The Happiness Trap, which also comes at an illustrated version that you can read in like 30 minutes, has some really great outlooks about how to capture your thoughts and use mindfulness and separate yourself from your thoughts. And I have really, myself and a lot of my clients and students have got a lot and gotten a lot out of it.

Mary: So and we do have a podcast with Jonathan Tarbox on ACT and we can link that in the show notes as well. So thank you all so much for joining us today on the Autism Round podcast. It is April. Autism Awareness Month. And my books just launched Now when the time is airing, So Turn Autism Around Dotcom for all the details about how you can get the book and also that same email or that same website term autism outcome for all the book resources. So all the assessment tools, all the everything that's in the book that you might want will be able to be downloaded for free at TurnAutismAround.com. So hopefully we can really continue this conversation about how to bridge the gap between parents, SLPs, BCBAs and all professionals to help each child reach his or her fullest potential. So thanks again for joining us.