Ethics for Behavior Analysts: The Top 3 Mistakes We Make With Behavior Babe, Dr. Amanda Kelly

Transcript for Podcast Episode: 232

The Top 3 Mistakes We Make With Behavior Babe, Dr. Amanda Kelly

Hosted by: Mary Barbera

Guest: Dr. Amanda Kelly

Mary: You're listening to the Turn Autism Around podcast episode number 232. Today I have my good friend Amanda Kelly on the show. She is also known as Behavior Babe. And Dr. Kelly and I are going to discuss three big ethical mistakes behavioral analysts make when working with families. And we actually spilled over into five mistakes. And Dr. Kelly, just so for those of you that don't know her, she's been on the show a few times before. She has her doctorate in behavior analysis from Simmons University and has worked as a paraprofessional, a teacher, school counselor and behavior analyst in homes and school settings. And she has a new book out for behavior Analysts all about Ethics. So we are talking about ethics, and families definitely should listen as well, because we have a lot of things that can happen in your presence and ways for you to help behavior analysts and RBTs and paraprofessionals and school personnel get along better too. So hope you love it. Let's get to this important interview with Dr. Amanda Kelly.

Intro: Welcome to the Turn Autism Around podcast. For both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host, Autism mom behavior analyst and bestselling author, Dr. Mary Barbera.

Mary: Okay, Amanda, Amanda, thank you so much for joining us today. I know I had laryngitis for the first time since college. Then you had laryngitis the following week. So we've been trying to get you to come record for a couple of weeks now. So thanks for joining us today.

Behavior Babe, Dr. Amanda Kelly on The Turn Autism Around Podcast

Dr. Amanda: Absolutely. Thanks for having me. And I'm so glad we both have our voices back.

Mary: I know it was kind of scary. Now we realize how often we speak. Okay. So you have been on the show a few times and we can link those in the show notes. So we got your whole fall into the autism world. And I think it was like a way back. Episode eight, I believe one of my very first episodes I know, more than four years ago, had well over a million downloads now with our weekly shows. So you have been here basically since the beginning and you have a lot of ethical expertise. But just to catch our listeners up real quick, your two minutes fall into the autism world and where you're at now.

Dr. Amanda: Awesome. Thanks, Mary. I'll do it even shorter than that. You know, it really started as a background and passion and teaching and education. I've always loved learning and teaching others what I learned and learning more from others. And when I was in my undergrad, I saw a flier that a child with autism didn't know what autism was. They wrote ABA on the flier, and didn't know what my professor didn't know. So, you know, just cut to the chase, go meet the family, ask them, find out for yourself and everything. Everything from there is just history. I decided once I graduated, I was going to pursue behavior analysis. I now have a doctorate in behavior analysis. But I think more importantly is how big and how small our community is. Over the years, I've had a chance to practice in West Virginia, Massachusetts, Hawaii, and now Florida, and I'm still in touch with that first family. And Mary, you recently got in touch with that first family, which is kind of cool as well.

Mary: Yeah, You posted something about the first little boy that you worked with and the mom interjected, you were hiding his identity and everything and the mom interjected and put a comment, Oh, you can share his picture, no problem. And everything. And I clicked on her link to see and she happens to live like in my county, probably about a 15 minute drive from me. Which is so funny. She didn't live there, you know, until recently, but it's a small, small world. So we might have Amanda come out this summer and reconnect with that first family and reconnect with me. So, you know, all good. So when did you become Behavior, babe? And how did that happen?

Dr. Amanda: Well, it happened by accident. And here we are 15 plus years later. It was while I was working for a public school district in Massachusetts. And I was on IEPs. I was working in the school district. So I was supporting teams, doing some home and parent training caregiver interactions, and I got injured and was out of work for several months. And during that time, nobody stepped in to take over the role that I was doing for those families and for those children and teachers and parents started reaching out. And I was thrilled by that. I was like, Oh my gosh, last year you wanted nothing to do with that. I know you didn't want to hear about behavior analysis or who is it? Who's Amanda? And the following year, it's a teacher being like, I had this concern. I have this challenge. I created a data sheet, will you take a look at it? Yes, Claire, I will definitely take a look at it. But turns out when you're on workman's comp, you can't do that. You can't be working while you're not supposed to be working. And so I figured out with one hand it was a shoulder surgery, how to create a website. And I created a website with one hand and password protected that information. And basically I didn't give anything to anybody that wasn't publicly available. You just have to have some password to get there. So I don't know how they found the password or how they got to the website, but once they were there, there was just freely available information. Needless to say, I didn't keep that position much longer. I finished out the school year and my medical care and decided to open the website and started asking people, Is this valuable to you, paraprofessionals, or other teachers? I was working in schools still, and I remember some people will be like, Nobody will ever care. Nobody will ever look at this information. And I thought, Well, it's a good distraction from my dissertation or my grad school. So I just kept doing it. And then in 2009, which was the following year, Twitter was like coming to be and we were going to conferences and we wanted to post 140 characters about this great talk, this great presenter, Mary Barbera, Turn autism around hashtag. But we were like, Got to keep your phone away. Don't let this presenter see you doing it. Obviously that's changed a bit how we handle our phones in public spaces, but we had to have a name and there was Missbehavior, there was a STIM function, there were some really cute ones and creative ones and I thought they've all been taken and that's not true. There were only about three behavior analytic names out there in the space. And so I went, behavior, woman, behavior, girl behavior, person behavior, lady behavior. And I was like, behavior babe, alliteration is my thing. So I put it in when I was in my twenties and here I am in my forties and it's stuck. So it's now a website, it's a social media channel podcast as well. And it's just I'm grateful for it because it's very memorable. My first website address was ABAMA.webs.com, and I joke that that really, really rolls off the tongue. No, it doesn't. So behavior, it sticks, it's memorable, that me.

Mary: So it's behaviorbabe.com

Dr. Amanda: Behaviorbabe.com is the website and you can email me at behavior@outlook and if you want to find me online, it's just @behaviorbabe. So keeping it simple.

Mary: Yeah, I love that. I love that. I remember meeting you for the very first time in person and we were at a conference. I don't know if it was 2009. It was after my first book and you were standing by a poster about dissemination and you had your little character icon Behavior Babe. And I was like, Hey, wait, that's you.

Dr. Amanda: Who's this behavior? Me person? Like, it's. It's me. It's me. And I remember feeling so absolutely foolish being in a space using that professional name or not being introduced. At the time I didn't have my doctor, but now Dr. Kelly and I remember it was Judah. It was my friend, colleague and mentor due to Acts who first introduced me at a professional conference as Behavior Babe, and I just turned completely red. Now people meet me and they're like, Oh, it's Amanda. Okay. Hi, nice to meet you. And I go, Oh, you might know her as Behavior Babe people go, Oh, behavior B And I'm like, Oh, okay. So she's definitely much more popular than I am. And that's okay.

Mary: Yeah, Love Judah too. I should have him on the podcast. We should do that. Okay, so let's get to our topic of ethics. And so as behavior analysts, we know there's a lot of parents and other professionals listening, and if you are a professional, then you have to adhere to some ethical guidelines from somewhere. And we, as behavior analysts, need to adhere to the BACB ethical guidelines. But so you just are publishing a new book. Is it out yet?

Dr. Amanda: The digital print is out, so it is available in PDF right now. I coauthored it with Emily Schraga and Lara Bollinger and they published it going to say it's called Back to Basics Ethics for Behavior. Analyst We really, yeah, we really feel like it's just time to simplify these conversations. It's not about the cup of water or the cup of coffee. I'll explain that more if people need it. And really, just what does it mean to meaningfully appropriately engage with the families, the clients that we serve? How can we do it ethically but also still in a way that's effective and fun and relatable?

Mary: Okay, so it's out in the digital print. Is it coming out in a paperback or hardcover?

Dr. Amanda: It is, yes. It's coming out in July, so it'll be available at the beginning of July. It's written as a textbook, but it is also written in a way that I wanted. I wanted to write something that I would put on my shelf after 20 years in the field. So it is not intended just for students. Hopefully the more seasoned analysts as well will see themselves, their journey, their history, the different forms of their career, and some of the ethical scenarios that we put in the book. We have over 50 that we explicitly included in the book.

Mary: 50 case studies or?

Dr. Amanda: 50 scenarios and dilemmas to walk through. Yes.

Mary: Okay. So how did you become an expert in ethics?

Dr. Amanda: It started just with a passion in behavior analysis. When I saw how effective the science could be, how effective the science is when implemented correctly. I just thought, wow, we should all do it. We all must know about it. We have to give this to every person who needs it, every family out there that wants to access it. Let's do it. But what good is it if it's low quality or if it's not ethical? And so when I was creating the website, everyone needed a little tagline in mind with the Disseminator for the ethical and accurate application and dissemination of behavior analysis. And I always wrote about ethics there. Maybe it was lingering from my grad school days. I'm not exactly sure, but I was like, This is important. And now I teach ethics for B Path University. I've been doing that for over a year. I worked on the Ethics book itself and really I think some of it is just putting myself in some pretty unique situations where I encounter things. I'm like, Ooh, I don't know if anyone's been here before, and if so, they didn't leave me a roadmap. So it's definitely been a lot of what I call walking face first into spiderwebs. So in our book, the cover is a Spiderweb, and we picked it because we sometimes say ethics or ethical dilemmas or problems..They're translucent. You don't see them sometimes until you walk face first into them. And so we kind of use that imagery to explain how easily we could find ourselves in an ethical dilemma.

Mary: Yeah, Yeah. And I think there are, you know, also with ethical dilemmas, there is not usually one right and one wrong answer, it's not very black and white. A lot of times it's gray and a lot of times you have to really analyze the situation to come up with, you know, a couple options and then pick the best one. Like it's not very clear cut. And over the years, because now it's two decades now since I've been a behavior analyst and the ethical guidelines have definitely shifted and evolved and sometimes in a good way, like you joke, which, you know, I'm sure the parents out there don't know what you're saying when you're saying, you know, it's not about a glass of water. And when I was a newer behavior analyst in homes, in schools at Christmas time and those sorts of, you know, holidays, parents often gave the behavior analysts and therapist presents. And we even brought our clients presents sometimes on their birthdays and that sort of thing. And then I don't know what year it was, but the ethical guidelines said, no, no gifts, no exchanges of anything. And then some behavior analysts took that to be like, you can't even accept a glass of water or a cup of coffee in a client's home. So it kind of went too far. And now the 2022 guideline, what does it say about getting out? Amanda, do you.

Dr. Amanda: Do gifts? It does. They do. It says gifts are acceptable under $10. And there are some cumulative parameters there. And that mimics what we see with Medicaid policies or insurance policies. So I think when we saw that the restrictiveness in our field was more restrictive than for medical professionals and we are in the medical space, some of us, that there was a shift. There was a great publication by Ben Wittes and colleagues, you know, but it was like behavior analysts accepting gifts. So what are we going to do about it? And they really called it out like there might be this parameter, but this is not necessarily practical and it could disrepair our relationships. And we need these relationships to have effective outcomes for our clients and the families we're working with. So what do you do if the ethical code conflicts with itself? I mean, you're back, right back to what you so succinctly described is a decision making process. You know, there isn't one right answer except for a very few couple of things. You do need an explicit contract. You must maintain confidentiality. Okay. Sure. But many things, it's all about triaging and problem solving. And so the problem that I find with any document in any field, any ethics code. When it's read on the paper, it's written in and taken for those words in black and white. It is a decision making process that we have to do, which involves our histories, our mentors, our friends and the clients that we're working with. So I think that the code itself is a huge improvement or evolution, I should say, from the first iteration. And I think that we always have space to grow and as our field shifts, as society shifts as well. So for example, there was nothing about social media and the first version of the ethics code because social media didn't really exist when it was published. So there's other examples of things that will come up over time that need to be addressed explicitly. So I imagine we'll have future iterations, but this one just went into effect this year. So this is the current code and it will be good for a bit.

Mary: Yeah. And you wrote a great article we can link in the show notes to on social media and ethics. And I think we talked about that in one of your episodes. So Amanda, your episode this time is 232. So Mary Barbera.com/232 we'll get you to all the show notes if you're listening on a podcast app. Okay. Let's get into the three big ethical mistakes professionals make when working with families. So I know you spent some time thinking about this. And so what's your mistake, number one.

Ethical Mistake 1: Professional Jargon

Dr. Amanda: All right. Mistake number one. Let me start by saying that these are mistakes in other professions that other professionals could make. But I'm a behavior analyst and an educator by training. So I'm going to speak from that perspective. And I'm going to speak about the profession that I currently represent. I think it really comes down to our language, our way in which we communicate. This could be the words we're using, like the word punishment. The word punishment and the field of behavior analysis means to decrease, literally means to decrease. But if we say to a parent like, oh, I'm going to put a punishment procedure in place, that doesn't translate well, and it's not exactly what we are actually trying to say. And ethically speaking, we would put reinforcement procedures in place first. But I wanted to pick something that has one definition for the rest of the world and a different one for us as analysts. Another thing that I see people doing is they will use the jargon words, almost like real words and really do think because we've used them so much that they are real words. For example, Manding comes from the word, Mand comes from demand, command, reprimand is my understanding, their standard verbal behavior. But when we say to parents, oh, he was doing some great manding today. I don't know what that means necessarily, especially if I'm entering a new into the services or into the relationship. Why don't we say things like we're really going to find what motivates your child and help them get the words are the ways to get what they really want in their life. And today, that went so well. By the way, we call that manding. If we even need to give them the language for it, which can be helpful if families want to search information on their own or look at any of the evidence that we might be finding. Okay, great. That's the term. But why are we talking like that and why is it written that way in reports and treatment plans? I know from my own histories, Mary, I would write, you know, behavior assessments, FBA. And even when I put in the word antecedent into a professional report, I would put events that come before the behavior. So at least there's the definition in the context, because if people can't understand what we're saying, then it doesn't matter how amazing the advice is that we have or the information that we could provide them. So I think the very first one is the jargon and the language. And I would add to that, it's also the way in which we deliver the information. So if we say to you like, Oh, I'm going to find things that are really motivating to your child, then you don't have a lot of confidence in what I'm saying because of how quietly I'm saying it or how sure I am saying it. So analysts out there who are listening practice this. Talk to people in your life. Explain to them the procedures that you might work with the client on and try to explain it without using behavior analytic terms. I remember when I was doing my graduate degree, we spent semesters learning how to be professionally precise and accurate, where I thought, all I'm going to do is publish scientific studies at this point because that's the only person. Even then, I don't even know if my colleagues would understand that level of jargon I was trained towards. And then I remember and the second to the last semester, they swung this back and wouldn't allow us to use any of the technical jargon and everything had to be in everyday speech. And I remember getting frustrated and I said, This is not fair. You just trained me to do this. And they say, That's great. We taught you to think like a scientist, but we need you to speak in a way so anyone could understand. And I'm just so grateful for that experience.

Mary: Yeah, I think because of my nursing background, actually, I feel like I'm particularly good at translating, you know, because the medical doctors would give, you know, or the radiologist would give a really scary kind of big language. And then I considered it my role as a nurse to, you know, try to explain it in layman's terms. And when training individuals, you know, my dissertations on training and I've always trained even knew nurses I was in charge of like staff development for a year or two. And it's like new people, whether they're parents or new professionals, they need to make sense right away. And I feel like my books are probably among the best in terms of really saying things in layman's terms. And even my courses and the fact that parents and professionals are together in my courses and communities, you know, we right away just dive into making it as simple as possible and not just terms acronyms. I feel like every time I have somebody on the show, a behavior analyst, for instance, a whole lot of acronyms get thrown out there. So I'm always like, I haven't had to do that with you, Amanda, because you're so good at it too. But like, okay, wait, wait. VIP, FBA, ABA, IEP, you know, just all these acronyms that we use that are overwhelming.

Dr. Amanda: You know, it's so I was laughing and smiling, as you're saying, about these acronyms and also about people who are learning the science or learning how to implement it, not just caregivers and parents, but professionals entering. I was bought in because I saw the effects. Then I went to school and was like, Oh, okay, stimulus equivalent. Okay. Oh, you mean that's what I did when he did that? Okay, got it. So it was really connecting it to experiences, connecting it to outcomes and giving those names and labels. I do recognize that for some of my graduate students, they are entering directly into the program, maybe without some years of experience, or they're getting it simultaneously that they're in the program. And I'm teaching ethics. That's their first semester. And I have to remember that they're learning how to be graduate students. They're being nervous, I'm sure, about how to write research papers. How to look up things. And so a lot of what I do in that class is I don't throw terms at them and I give them explanations and give them stories and they go, Oh, yeah, that's and they're making some of those connections. But the acronyms came up and they were like, Why do we have so many? And I'm like, Well, it's not just us. Like, we could certainly look at other professions, but it is profession specific speak where yeah, you have a VR and FR our schedule I heard an analyst say to a parent, Oh, he's doing really great. We're on FR3. And I was like, You're on a lot. I mean, I'm a behavior analyst. And I was like, what? Like I could break it down, use my brain to think about what that meant. Oh, fixed ratio. Okay. Every third respect. Why don't you just say we're giving him his token after every third response like that would be a little bit less to translate. And I think the reason is because a lot of us, as you know, it's one we're in sometimes echo chambers of other professionals. So we are speaking a lot to other professionals and we get a little bit stuck in that way of speaking. And I think the other thing is maybe we just don't have the experience and we're still working on that back and forth. Translation Yeah.

Mary: I wrote an article published in 2007 The Experiences of Autism, Mothers who Become Behavior Analysts. And there are a couple sections about, you know, the novice to expert training model as well as kind of on the job training like us parents get our you got as a therapist for a little boy and then going into it it really does make a whole lot more sense especially for us with experience. We can link that in the show notes. It's a great article. It's kind of a classic now that yeah the journals out they don't make the journal anymore It was like the Journal of ABA and SLP or something like that. But anyway, it's a great article to think about training and on the job training and, and going into these technical terms. But moral of the story, we need to use language that not only the parents and the families are going to understand, but also the newer people and the multidisciplinary team, which is a whole nother, you know, group of people who could be easily turned off by our jargon.

Dr. Amanda: Absolutely. And I think it might be my education background that gave me a lot of experience with that, working with coaches, occupational therapists, physical therapists, speech and language providers, clinical psychologists. And many of those experiences were very positive and very collaborative. So I and most people at the time didn't have a history with anybody who was a behavior analyst. So I didn't have to go in and build up or break down and rebuild. I just came in and tried to establish. And so, yeah, I really appreciate you mentioning that because that's another place where if we are part of an interdisciplinary team, we get to have that practice and keep practicing using language people can understand for sure.

Mary: Yeah. Okay. Mistake number two.

Ethical Mistake #2: Be Cognizant of Cultural Histories, Traditions, Customs, Norms, and Experiences

Dr. Amanda: Mistake number two. This one starts with a personal story. And I originally had kind of titled it Be wary of the easy yeses, but I think that actually is summarized by being cognizant of where you stand and other people's cultural histories, traditions, customs, norms and experiences. So for example, once I was working with a family and they wanted to expand their son's meal repertoire, the foods he was eating right. Let's get beyond the beige diet, have medical clearance, of course, make sure that that was appropriate and that we could be working on it behaviorally, and we were ready to do that. And so I had explained a bit about the first. Then here's something that you don't love to eat, followed by something you might love to eat. And I was like, Does that make sense? Do we get it? The mother stated it back to me and she was like, Yes, got it. Absolutely. Yes, We're definitely going to do that. Yes. And I remember feeling really, like, accomplished. And by the way, this was like at least five years post my PhD. So this was not an early career mistake. This was not too long ago, a lesson that I am still holding on to and sharing. I remember leaving feeling successful, but also feeling like that was too easy. That was too easy. There's a lot of steps to this. I just asked her to change how she prepares meals in her house, and she has a household, not just her son, to care for. I don't know. And I remember thinking, I don't know about that. But, you know, she said, yes, everything's good. Let me go on to my next case. Let's get to the weekend. It's a lovely weekend. And when I went back home, which thankfully was just the following week, there wasn't a long time in between. I said, So how's it going? How did it go? Did you try it? What were your thoughts? And she says, Dr. Amanda, I have to tell you, I didn't do anything you said. And I feel bad that I'm going to tell you now. Now it's like, Oh. That was my fault. That was my fault. Oh, and so. And I did. And I loved that she said I didn't do it. Like how great that she felt comfortable enough. Maybe not in the moment, but later to be like, I didn't do it. And then what she said was, I sort of did my own thing and it went horrible. And so now I would love to try your thing, but here are some of my concerns with it. And basically, she had shared her history and experiences growing up in a third world country. And like you don't take food and take a bite and put the rest in the trash or put it in the fridge for later. That was not how her relationship or her family's relationship was with food. And I missed an opportunity to say, really, I guess, tell me what you normally prepare in the household or maybe ask some of those questions. But I didn't realize, like, oh, that's what you guys are going to eat for five days in a row. And because that wasn't my history or my experience, I often had a lot of food out of cans and in microwaves. I don't know if that was the eighties or being a military brat, but I didn't really have a lot of experience around that. And so to me, it's one thing to say, let's be mindful and aware of cultures, customs, traditions. I remember a family when I lived in Massachusetts who always wanted people to take their shoes off, and that felt very strange for a lot of our techs and people going into the homes. And they didn't want bare feet and they didn't want socks. So we purchased for them house slippers that they could wear in the house that the family was comfortable keeping in the house. And we labeled people slippers and here's your house slippers, and you're not going to wear your shoes in their house. Then I moved to Hawaii and that would be like that was just standard. Like, No, you're not walking into my house with your shoes on. And it would be almost unusual if you asked to be like, Read the room. Do you see the 500 pairs of shoes outside on the porch? Okay. So some of these things are a bit more obvious. If we pause and just assess and we look at some of them, that's why I felt like saying accepting a yes. If it's too easy, that should be an indicator for you. You might have missed something and you might need to ask more and it might have to do with that person or at least history. Another thing that Mom told me was You're a doctor. Like I don't disrespect or say no to somebody of higher authority. So I didn't. I didn't feel like I could tell you no, and I, again, needing to be aware of that, can't remove my doctorate. But it is very important to realize that some cultures will do what you say because of who you are, who says it. And that's not always in the best interest for the family or the child if they have another way that they really could be doing things in the family, in the household that are much more effective and in line with their values.

Mary: Yeah. Yeah. I think you said a lot. They're an ethical mistake, too. And I know I didn't before I was consulted mostly at home starting in like 2000 and whatever year. But, you know, working with families in different cultures is like the shoes, you know, even the little boy where we did take our shoes off and no one more shoes in the house, he was having a problem because he was when he was potty training, he was taking his pants all the way off. When he was sitting on the toilet, which. You know, that's a problem because then how are you going to get them independent and come out of a bathroom pulling himself up and washing his hands like it was a problem? Right. So my first, you know, suggestion would be to have them wear shoes because you can't really get your pants off easily if you've got shoes on. But I knew that their culture was such that shoes weren't allowed, but they could have, like you said, like slippers or something in the house, like it is more of a clean, dirty bringing dirt in. At least it was for this family and this, you know, whatever culture they were from. But so we managed to get inside shoes that he could wear during the day so that it was, you know, helpful. So that was a problem, you know, that we overcame also that same family, you know, it wasn't abnormal for them to mush down all their food and to spoon feed their kids very late for our culture and also to sleep in a family bed.. So those were some of the differences that I was not familiar with. And also, it's not just culture. It can be race and religion, too. I featured the woman, Maria. She's the founder of Autism in Black. Yes. And link that in the show notes. But she has some really good stories about, you know, the African-American culture and their relationship with religion and intellectual disability and just all kinds of things that are great in that episode. So we just, you know, and it could be a white family that lives down the street that has a different history or different preferences. And, you know, I like that whole, you know, not just taking the easy yes. And really, we're not just assessing the child and their strengths and needs or assessing the family, what's doable for the family, what's practical and what's motivating for the family? Because if the family's not motivated to at least try it, it's not going to be tried. It's not going to be successful. So I said this I think on a recent show, you know, I worked a lot of times with the Verbal Behavior project, we would be two behavior analysts, like a junior or a BC-ABA or somebody studying to become a BCBA and then a BCBA like me. So I was also training a behavior analyst. And I remember some gung ho behavior analysts in training that were like, okay, we're going to do this, this, this. And I'm like, you are on the bus by yourself. The bus has taken off. No one else knows what you're talking about. No one else is on board, literally on board with the bus that just pulled away. So you need to turn the bus around down and let's assess what's doable, what's motivating, not just about the kid. If you don't have the adults on board, it's not going to work.

Ethical Mistake #3: Asking Too Much

Dr. Amanda: That's a perfect segue into what I think is big mistake number three, which is asking too much, not understanding the perspective and forgetting that we are there to make the family unit operate better. So meaning we're there to help. And if it's not helpful, then we have to adjust. So I think lots of mistakes I see in this area are those gung ho professionals who are excited to help, who are eager, many of whom maybe have recently graduated. And do you want to save the world? That is an exciting thing. And that energy can be a bit much when it's like, okay, listen. The first thing I really like to do is I would just like to get out of the house and it might take 4 hours and I just need to be able to do that once a week. Okay, I see where you're at. Sometimes I think we lack that. Where are you today? Question and we don't realize the journey to get where we need to go. We're just like, okay, so he's going to be off of college and driving his own cars, like, Whoa, whoa, whoa. We're talking about a two year old, a mom just to get out of the house. So, you know, actually, I'm kidding. Most analysts may not even be thinking 30 years ahead. Please do try to think that way, too. More experience will give you that. But really what is meaningful to the family? So the first question that I often will ask a family and if anyone's ever asked me this, I think it's great. And if they haven't, maybe start thinking of this for the parents out there and say this when you have a new professional working with you, I always ask a parent if I had $1,000,000 and a magic wand, what's the first thing I could change for your family? And they'll tell me and they'll tell me these really big, lofty, not impossible, but long term goals. Right? And I ask them for a magic wand and $1,000,000. I want your biggest, biggest long term goal. I want to know what it is. And then I'll say, okay, what's number two, three and four on the list? Like, now just walk me down a little bit. Just put them in order. And I have found asking the question in that way allows parents to say something that they may feel is not attainable or say something that they hope is attainable. Great. Say it because I want to know where you're at and I want to know how to get you and your family there. But I'm never going to get you there because it's going to take a lot of hard work unless you can trust me, unless I can show you I can be effective. And until we have a relationship where we're willing to go elbow deep together, if that's what it takes to get to that number one target. And what I find is we often get there. Sometimes we make great progress and we don't always achieve exactly that million dollar magic wand goal. But we get there a lot of the time by saying, like, I can't tell people, like I need you to work with me and I promise I care about you. You have to show people that you care about them. They have to believe you. They have to see like, Oh, now my son just tells me he points to the fridge when he wants me to get his milk out. Okay, that's an improvement. I see you're helping. Can you help me more? Okay, I'm willing to put more and invest in this. And not because parents aren't willing to invest. But I believe that they're always giving us their all. And if that is not enough and I'm using air quotes, it has to be enough. And so as an analyst, it's how do you walk in and look and assess and see where the parents are at and meet them there and create relationships and change that will be meaningful. I see this in caregivers. I review a lot of treatment plans. I have that vantage point and what I see there is that the caregiver will learn the four functions of behavior. The caregiver will deliver a token upon the second occurrence of the desired behavior within 30 minutes. It's like, Stop it.

Mary: Knock it off.

Dr. Amanda: I just get off that bus, get off of that one. Get on a new one. Get on one that has people on it and just think like, you know, we get where we're going by taking small steps, though, take small steps. And a small step to a family is not a small step. It is a huge step, meaning that the effort that we're asking them to do, for example, we had I had a client once who would get aggressive and self-injurious if you told him no about a lollipop or going to the bowling alley, and he would ask these questions in the hundreds of times per day. Can I go to the bowling alley? Can I have a lollipop? And sometimes people would ignore it, and sometimes they would say no. If they said no, it would be aggressive or self-injurious. If it said no, it would usually intensify. This is I'm simplifying the intervention for the purposes of this podcast. But one of the pieces of the intervention was the shift in language to when can I go to the bowling alley? When can I have a lollipop? And he started to understand. Time, X amount of sleep, things on the calendar. We are able to give other pieces of information. You break it down. I can't get in his head. But perhaps he had some anxiety about when he was going to get to do his favorite things. He didn't know when they were going to happen. He's five. How much control did he have over his life? So, yes. Well to the parents. I wrote on a little flashcard. When. And I stuck it on their fridge and I was having a conversation with the family. I didn't just do it and walk out of the house. Let me be clear. We were talking about this.

Mary: Mess up your refrigerator.

Dr. Amanda: Let me just put pictures all over your house. No, no, no, no, no. Not that either. But I said she was saying, like, this is really helpful. This is actually working really well, but I forget to prompt him to say when. And I was like, Cool, let's write on a flashcard. How do you feel about throwing it up in your fridge? And she was like, Got it. Come back the next time. And he was like, Miss Amanda, I'm sorry. I go to the bowling alley. Like, he didn't ask me. He told me when. And I was like, Whoa. And she's like, You know, now you can have 100 lollipops if you want them, because he's not aggressive while he's asking. Obviously, she didn't give him 100 lollipops, but it was more of like, Oh, my gosh, it was just a win and not win. But we all did win, win, win. But that simple strategy of like, okay, let's just go up here because she was forgetting I didn't say, Oh, mom will remember to do this six out of seven days with 90-100% adherence or else we're going to cancel her support. No. It's like, okay, I am the one who has to adjust. I am the one who has to revise what I'm doing. Now, there is a point where parents say, Yes, I'll do that, Yes, I'll do that. And no, they don't. And then we still have to really assess, like, what's the barrier and can we remove it so that we can provide effective care. Though I don't mean that we shouldn't involve parents. I definitely know, Mary, we're on the same page with that. Parents get as involved as you can. Their children are awake for 100 plus hours. Right. Mary, we know that. Not 40 hours of therapy. That's right.

Mary: So we can encourage parents and enable parents to be the captain of the ship, especially if you're in their home. You know, you don't get to just go in there and just work with the child. It's the whole everybody in the household. You have to pair with. You have to assess their needs and wants and desires and histories. You need to, you know, get everybody on the same page because intermittent reinforcement is so powerful. And, you know, I love the magic wand for $1,000,000. And I always say, you know, if I give you $1,000 for your child to have a good day with no problem behaviors or $1,000 for the hour, you know, what would you have to do? And what you would have to do is you would have to raise the reinforcement super, super high and lower the demands super, super low. And then once you get into that state, then you inch by inch start increasing your demands and lowering your reinforcement. You have to do that for the child. You have to do that for the parent. If you see a problem, behaviors that could be the mom crying, getting testy because you're not listening, whatever the demands are too high and or reinforcements too low. So you've already and this is not to, you know, make any behavioral analysts or any professionals out there feel badly. We're making a thousand, 10,000 decisions a day. And it is like it is a very fragile dance, you know, especially when you're talking about different cultures, multiple kids, multiple languages, perhaps. It's hard. It's hard to be in. There are a lot of times by yourself, right? Without a ton, a ton of experience. So I really do take my hat off to any professionals, especially those who are going into homes or working with families because it is so complex, the kids are so complex, and then you layer on the families making it even more complex.

Bonus Mistakes #4 and #5

Dr. Amanda: Yeah, I would you know, I know we're going to stop at three, but I would add number four is that we forget. We forget that we can use the science of behavior analysis in all of our environment and all of our environments. And we forget that everybody around us needs to access reinforcement. And when that schedule, I guess, is another way to say it for the analysts out there, when that schedule is thin for the families, you're going to lose them. And we're never going to get where we need to go without those incremental steps, just like you were saying, Mary. And then I'm just going to go round it out. We're not going to talk about it too much. But the fifth and final one now I'm just doing five expecting perfection. You made me think of it when you said it's hard for the analysts. It is a lot to juggle and to challenge. And so a mistake would be expecting yourself to be perfect. A mistake would be to expect yourself to never enter into an ethical dilemma. A mistake would be to believe that you're always going to get it right.

Mary: Right. Or beating yourself up for, you know, forgetting that they eat, you know, mushy food and they don't have this or forgetting to take your shoes off or whatever, don't beat yourself up. Like let it roll off you. It's okay. You know, you'll learn for next time. I mean, Amanda and I have made many, many mistakes along the way. And so we share them. Share your mistakes and talk about ethics in your school, in your organization, in your clinic, and even families listening. The behavior analyst needs 8 positives to every negative, too. And the RBT, you know, I hear families say, well, he RBT showed up. She didn't even have any experience. It's like somebody showing up if they are, you know, willing to learn, bring them in, sit down, pair with them, sit down and show them what you've learned about table time with your own child. Teach them. Well, it's not fair. They should become trained. That's just not the way the world is going to happen. So we all need to get along like, you know, I'm looking for a person for Lucas right this second Tuesday and Thursday. It's like I'm not expecting somebody perfect to walk in. It's hard to find people that want to work, that want to show up, that have good clearances, good driving records. You know what I mean? Like. Don't dismiss people because they're not perfect either. You know what I mean? Like, bring them.

Dr. Amanda: This is so valuable. Mary. I was a person who showed up at a house with no experience and I'm Dr. Behavior Babe, So, like, you really don't know right where that's going to go. And that doesn't mean that'll be everybody's trajectory. But I really do appreciate you saying that for the listeners and also, again, for the analysts out there. Bring in the people who are coming into this field, welcome them, make them want to be here, make them want to stay, because the more that they're here, the more that they contribute, the more that they stay, maybe a little bit less about anxiety or stress. The analysts might be here. We can distribute that and kind of really create a more robust community and continue on that path. So at the end of the day, I would just say. Well, actually, I already have said this. I said it's like walking into a spiderweb. One of the things I say is every new day I learn that every day a spider will rebuild its web, meaning every day there will be a new thing to potentially walk face first into. So just keep your eyes open, Keep your heart open. And like you said, Mary, continue to have conversations and talk about the mistakes, talk about the growth and help others grow with you. That's really I really appreciate coming on the show and having an opportunity to have this conversation. Mary.

Mary: Yeah. Yeah. Well, I think that's a great way to wrap it up. I will ask you one final question, but before I do all this talk about training others and being positive and positive to every negative. I did a fantastic interview with Dr. Scott Geller a few weeks ago on the podcast, and Amanda connected us. He is an amazing guest. He has a lot of great resources, so check out his podcast. We can link that in the show notes as well. But I do think that using his, you know, all of his positive energy with everybody will make our ethical dilemma lessen. Okay. Part of my podcast goals are not to just help the kids, but also help the parents and professionals. So what are your self-care or stress management tips for us to implement that you use?

Dr. Amanda: Okay. Well, I'm feeling really prepared for this question because I'm currently embodying these practices which have not always been a part of my life. The thing that I do is I take a walk every single day. And for me, that has started after I lost the ability to walk, I actually had surgery, back surgery the week of Christmas. And when I woke up, I was able to fully walk. And nothing like being able to lose the ability to do something to remind you how valuable it is. But for many of the families, it's just getting outside. If your day doesn't have sunshine, put sunshine in your day. For me, I joke that nature keeps rewarding me. Mary, yesterday I went on a just a quick walk in my neighborhood and I saw a white crane dive into the water and pull out two fish on its beak. Two fish, one bird. And I thought, Oh, that is so cool. And I would have never seen that on my couch in my kitchen. So stepping outside doesn't even have to be a walk. Just step outside and put yourself in the sunshine. I find that when things are confusing or overwhelming or too complicated for me, I observe nature and I find a lot of lessons there and it really simplifies the thoughts in my head. And so those are my strategies.

Mary: Nice. And you have made such a miraculous recovery. I was really, really worried about you when you were posting and you had to even use a wheelchair and air travel. Your back was. You were in so much pain and yet you always every day for years now, you have posted a gratitude on your Facebook wall, which is amazing as well. So that's another self-care tip that, you know, in addition to walking is such a thing that you're modeling for all of us. It's really fun to see that.

Dr. Amanda: I honestly forgot about that, Mary, because it's now just a part of my fiber and fabric and being. So that was a recommendation from Scott Geller. It's like the habits of happy people and things like that. And one is gratitude journaling. And I think it's to write down three things you're grateful for every day. I just do one, and some days there's 100 things. But when I was in the midst of the absolute worst pain. It was wonderful that it was a habit I had already had in my repertoire or I was already doing, because there were days where the only thing that I felt grateful for was like the smell of coffee or the cold floor on my feet. And it really pushes you through some really dark times. So I know that families and providers end up in places where we carry a lot of the stress and the burden and the responsibility. And so, yeah, gratitude, journaling. It's just become who I am now. Thanks for pointing that out.

Mary: You publicly post something which is nice. And so I do think that even when you are in pain and really struggling, you are still practicing that daily gratitude, which is amazing. So I'm so thankful that you're now feeling so much better and walking and enjoying life again. I can't wait to meet you in person again sometime soon, hopefully this summer. Thank you so much for joining us today and sharing some ethical dilemmas with us. And we will post a link to your book, to the Back to Basics, all about ethics for behavior analysts. So I'm excited to read it myself. Thanks again.

Dr. Amanda: Thanks, Mary.

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