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Posts Tagged ‘Missy Mondays’

graphHi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question was posted on a list serve for parents and family members of individuals with autism. The mom wrote,

“As far as data collection, I hear about the BCBA doing it but I have never seen it nor heard specific results. I requested the data and the BCBA told me that as an outside consultant she is not allowed to provide it.

Having taught a course on Ethics and Professional Issues for behavior analysts, and in addition to offering on-going coursework related to ethical issues for Board Certified Behavior Analysts, hearing things like this really upsets me.

Guideline 2.0 Responsibility to Client

The Behavior Analyst Certifying Board (BACB) has developed a set of Guidelines that BCBAs and BCaBAs must follow. These guidelines are called the Guidelines for Responsible Conduct and they may be viewed here. One of the guidelines states that “the behavior analyst has the responsibility to operate in the best interest of the client“. When the client is a minor or incapacitated (i.e., unable to make decisions for him/her self), the client’s parents or guardians become the client.

In the case above, the BCBA is claiming that her responsibility lies with the school district who is paying her salary. Unfortunately, the school district is a third-party payer. While the BCBA has responsibilities to her employer, those responsibilities cannot override her primary responsibility to the client. In fact, the guidelines address this issues.

Guideline 2.05 Third Party Requests for Services

This guideline has two parts. First the guideline states that “When a behavior analyst agrees to provide services to a person or entity at the request of a third-party, the behavior analyst clarifies to the extent feasible, at the outset of the service, the nature of the relationship with each party. This clarification includes the role of the behavior analyst (such as therapist, organizational consultant, or expert witness), the probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality.

The guidelines go on to state that “If there is a foreseeable risk of the behavior analyst being called upon to perform conflicting roles because of the involvement of a third party, the behavior analyst clarifies the nature and direction of his or her responsibilities, keeps all parties appropriately informed as matters develop, and resolves the situation in accordance with these Guidelines.

So, while the district is paying for the services, the client is the child and his/her guardian. When he client requests their data, the behavior analyst must make those data available.

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Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior. Today’s question comes from a team of professionals who provide feeding therapy to children who are struggling with eating. The team writes,

“Hi Missy, we run a feeding clinic and have recently been receiving calls from a number of parents with very young children. How young is too young to start feeding therapy?”

I thought this was a great question but I wasn’t sure that I had enough information. So, I emailed back and asked them to elaborate. Specifically, what ages are the children? The team responded,

“Well, one child is 11 months old and the other child just turned 2.”

I was stunned. It broke my heart to learn that a mom was struggling with such a very young baby. My first response was that 11 month old clients are still, technically, infants. Thus, my recommendation was for the mother to seek support from her pediatrician or even mid-wife. Of course, the team should recommend a good nutritional, gastrointestinal (GI), and allergy work up. If, after all of those referrals and support, the mother still struggled with feeding, perhaps the child and parent could attend behavioral feeding sessions. However, I would want to exhaust all support services for infants before starting services that are primarily targeted for preschoolers.

We have treated several two year olds in our clinic. However, each client approached or celebrated their third birthday during clinic. Additionally, we modify our intervention strategies slightly due to their young age. There is a big developmental difference between a 34 month old and a 24 month old. So, I urged the team to use caution.

Assess

First, teams should carefully assess all participants prior to commencement of feeding therapy. This is especially true for very young children. The assessment should include a thorough record review of the medical history including assessing for any history of reflux or other GI issue. Swallowing function should be assessed by an appropriate professional. Chewing function should be assessed to ensure that the child knows how to manipulate food appropriately in his/her mouth without choking.

Rapport

Given the child’s young age, the team should first establish rapport with the child so that he/she feels comfortable with each therapist. Second, the child needs to feel safe in the therapy environment. Of course, his/her parents should be present at all times. Finally, be sure to include play time before and after therapy so the child maintains positive associations with the environment. We recommend providing services in the home if possible. However, if not possible, the clinic area should be modified to meet the needs of very young toddlers.

Instruction

The team should take some time to teach the child some basic compliance skills like gross motor imitation, singing songs, or playing together on the iPad. Once the child has demonstrated an ability to follow basic instructions and he/she has learned that fun things happen following compliance, then it is safe to begin therapy.

Feeding Therapy

Staff should take care to utilize child-friendly approaches during feeding therapy. Staff should never trick the child to eat or sneak food in when he/she is not looking. Staff should, instead, focus on teaching the child to tolerate new foods and to pair new foods with reinforcers such as hugs, cheers, high 5s, and even songs or games on the iPad.

Good luck helping those very young children. We know that the sooner you start, the better the long-term outcome. Please keep us posted on their progress. We know they are in good hands!

If you have a behavior question that you need assistance on, please email: askmissy at appliedbehavioralstrategies dot com.

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Hi and welcome to Ask Missy Mondays where I respond to email questions from parents who are having difficulty with their child’s behavior. Today’s question comes from Amanda, who writes:

“Is there a specific protocol that should be used to decrease hitting and pinching in general?

My biggest concern related to hitting and pinching is how to keep everyone safe in the car. Occasionally my son will hit the driver. Is there some sort of adult sized 5 point harness that can be used so my nephew can’t reach the driver? Or some method of child-proofing the buckle so that it must be unfastened by someone else? (Like a toddler seat, only my son is bigger than me!)

Any advice you can give for car rides would be greatly appreciated!”

Amanda this is a fantastic question (or 2 or 3 questions in one!). You are not the first person to ask me about safety while riding in the car.

Unfortunately, we don’t have a standard protocol for hitting, pinching, or any other behavior. We respond to behavior based on its function or purpose. My first question would be “why is your son hitting on pinching?” My guess, based on the information you have provided, is that he is hitting for attention. Right? The driver is busy and not attending to the child, the child hits, and attention comes almost immediately.

Sooooooo, make sure you and whoever is driving refrains from giving him attention when he hits you while driving. You also want to make sure you give him lots of attention for good behavior while driving. You can also comment on things you see or use music to distract him.

Safety is a completely separate issue. All children should be safely secured in a moving vehicle.  If he is coming out of the seatbelt, then you may want to consider a different type of car restraint. However, if he is bigger than the adult, the options are limited. I would try to teach him to stay in the seat belt rather than use a harness. This could take some time. If he really likes car rides, you could pull the car over and stop temporarily for any violation (hitting or getting out of the seat belt). If he doesn’t like car rides, that intervention will not work and a different strategy will need to be used.

Good luck and let me know how it goes!

If you have a behavior or situation that you need assistance on, please email me at askmissy at applied behavioral strategies dot-com. Thank you!

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