Planning the activities and programs for a child who has autism has got to be challenging. What kind of person handles such a task? Cornerstone Autism Center’s Team Leads that’s who!
Their job is to create, analyze, and modify programs that the ABA therapists, who work one-on-one with the children, will implement. Sarah Winningham and Gina Warren are two of the three clinical coordinators at the West Lafayette, Indiana Cornerstone Center and they are Board Certified Behavior Analysts (BCBA) .
Jarrad: Gina, why did you want to be in the field of child treatment for autism?
Gina: I became interested in Autism during my studies as a Psychology major in the early 1990’s. I was voted “Class Clown” in high school, so obviously social attention is of importance to me. The idea that it wasn’t a driving force for children with autism absolutely fascinated me.
Jarrad: And Sarah, how does what you do at Cornerstone match two qualities you value in yourself?
Sarah: One quality I value in myself is empathy. I have always been very conscious of the feelings of others and the understanding of where other people are coming from. This has helped me in my work at Cornerstone when kids are struggling. It helps me to create better programs because I look at where they are coming from or why something is hard for them. Another quality I have is determination. I refuse to give up when something is important to me. That is a very important skill to have when working with kids who have challenging behaviors because I have to stick with it and know that in the end I’m going succeed.
Jarrad: What general steps do you take to make a program for a kiddo?
Sarah: It really depends on the child and the program. Some programs are easier to develop than others, and some programs are easier to develop for some children than others. We use the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) as a general guideline to help us see where a child’s strengths and deficits are, and then we develop the programs based on those strengths and deficits.
Jarrad: Although every clients program is customized to their situation, some programs are common with many children. What are some of those standard programs?
Gina: Most children with autism have deficits in language and social skills, so it is common to write programs that focus on attending to a speaker, asking another child to play with them, and so on.
Sarah: If anything, I would say a waiting program is pretty common, mostly because that is an area that many children struggle with, especially those with autism.
Jarrad: How do you coordinate with ABA therapists on a child’s progress in their programs?
Gina: The primary means of communication occurs each day while I am out “on the floor”, observing program implementation or addressing problem behaviors. If there are particular behaviors of concern, therapists can videotape a portion of the child’s day and “flag” it for their Coordinator to review. In addition, each therapist has the opportunity to complete a “Team Communication” sheet which describes any new behaviors, barriers to program completion, or errors in program uploads that occur during a session.
Sarah: Therapists spend 7 hours a day with their kids; they know their kids better than anyone else in the center so they are the best resource for how the child is doing. As clinical leads, we are always available to answer questions. Therapists can come to us at any time during the day if they have questions with how to implement a program or concerns on how a child is progressing. If a child is struggling with a target, the therapist lets us know and we can modify that target to add in more steps, or simply teach the therapists how to provide better support for the kids.
Jarrad: Sarah you recently became a Board Certified Behavior Analyst (BCBA). Gina and you are both BCBAs! What is BCBA?
Sarah: A BCBA is a Board Certified Behavior Analyst. I will leave it to the BACB (Behavior Analyst Certification Board) website to explain what a BCBA does. “The BCBA designs and supervises behavior analytic interventions. The BCBA is able to effectively develop and implement appropriate assessment and intervention methods… The BCBA teaches others to carry out ethical and effective behavior analytic interventions based on published research and designs and delivers instruction in behavior analysis.”
Jarrad: How long does it take?
Sarah: The process of becoming a BCBA involves obtaining a Masters’ degree in an approved area such as ABA (Applied Behavior Analysis) or Special Education from a university with approved courses. It requires 1500 hours of qualifying experience hours, such as working in an ABA center, with 75 of those hours being directly supervised by a credential BCBA. After that, potential BCBAs must pass a test to be approved by the BACB. The entire process takes about 2 years.
Jarrad: How difficult is it to get?
Sarah: There is between a 25-57% pass rate on these exams. They are very difficult and require extensive studying.
Jarrad: What are the benefits of having a BCBA?
Sarah: One of the benefits of having a BCBA is that it is the highest credential in the field of Applied Behavior Analysis. It distinguishes you as an expert in the field and shows that you are qualified to provide consultation and treatment for children and adults with autism.
Jarrad: Gina, what is the most rewarding part of your job?
Gina: To me, the most rewarding part of working of the job comes when a parent tells me that they can see a difference in their child’s behavior or, like in the example above, when a suggestion I have made has greatly reduced the level of stress in a family’s household.
Jarrad: And the most challenging?
Gina: Having little or no control over factors that affect the children outside of the Center.
Jarrad: What are some custom programs you’ve made?
Sarah: We have the ability to customize each program to every child’s needs. For example, when we are working on a “manding” program, meaning teaching children how to request what they want, we are going to create goals specific to what that child likes. That means that one child might have trains, cars, and monkeys as targets in his program while another child has princesses, crowns, and Care Bears. It’s all individualized.
Jarrad: Have you ever had a child with autism that you and your team had difficulty creating programs for? Why was it a challenge and what did you figure out was wrong?
Gina: Absolutely. In many ways, every child is a challenge to create programs for, simply because a good program challenges a child without causing excessive amounts of frustration. This at times can be a very delicate balance.
Sarah: It’s finding a way to make a target where the child is able to succeed without becoming too easy or having the child rely too much on their therapist’s interventions. There is always an answer; it’s just a matter of finding which steps are the best for that child’s skills.
Jarrad: Have you developed programs to assist with self-help, or living skills?
Sarah: Yes, for nearly all of my kiddos. Most children can use a little help with adaptive skills (even typically developing kids).Tooth brushing is a common one, so are dressing skills and washing hands. The idea behind these programs is to help the child be a more independent and active member of his or her family.
Jarrad: Any success stories of kiddos with autism you can recall?
Gina: Success is really measured based on the needs of each child, so no two “successes” look alike! One of my favorite success stories came from a family in Illinois. In that house, the child would scream when he was put in his bed and would awaken 5 times per night. Mom and Dad were exhausted and at the end of their rope! After developing and implementing a detailed bedtime routine, the child went to bed each night without a tantrum and slept throughout the night. The parents were grateful to escape the evening drama and get sleep for the first time in 3 years!!
Jarrad: How does a parent know if ABA is right for their child?
Gina: ABA is great in that it works with all human beings, even if they don’t realize it! Every choice we make is based on what we want more of (e.g., money, praise, attention, chocolate, free time, TV, quiet, etc.) and what we want to avoid or get away from (e.g., speeding tickets, reprimands from our spouse or boss, our child’s tantrums, noise, weight gain, etc.). I guess you could say that I think ABA works 99% of the time!
Jarrad: What are unique programs you have created
Sarah: One unique program I created recently was a stranger danger program. Some of my parents have mentioned that their kids are going up to strangers and hugging them or talking to them, which can be dangerous. This is a case to be careful what you wish for because we want our kids to socialize, just not with adult strangers. To accommodate the wishes of these parents I created a program for clients to identify the difference between strangers, friends, therapists, and family.
Jarrad: How do you collect data taken from the ABA therapists? What do you do with it after the therapists record it and hand it off to you?
Sarah: When therapists take data, it is recorded in our online program. Once a child has achieved mastery, which typically means 3 independent responses across two different therapists, the program’s marked as a mastered skill. All targets, or goals, are part of a larger target set, and are grouped by category. Once all targets in a target set are mastered, the computer alerts us and we can then introduce a new set of targets into the child’s program, which shows up on the iPad for the therapists to work on with the child.
Jarrad: What are the benefits of using iPads compared to other methods of data collection and analysis?
Sarah: The biggest benefit of using iPads and our online system is how quickly we are able to develop behavior programming. In more traditional data collection requiring books and paper programs are only updated once a week. This means that a child could master a skill on Monday but they won’t have a new skill presented for them until the following Monday. With traditional book programs, therapists have to carry around large binders and flip through hundreds of pages of data to mark down whether responses were correct or incorrect. With our system we are able to update our programs multiple times a day and as often as needed. Another benefit is the ease that therapists have in taking data. Our therapists have a light weight iPad that they can carry with them as they go. They can mark a response as independent, or what type of prompt was required, with one simple touch. This allows for much less downtime where the child has to wait while the therapist flips through a large binder.
November 5, 2012, cornerstoneac