That Moment

Part 2 of 2, Mia and Applied Behavioral Analysis

Mia, ABA, and School

With Kari Porter, MS, BCBA

By Alford Kerry Hardy

In Part 1, Kari Porter talks about Applied Behavioral Analysis, ABA.  Kari describes ABA as, “… looking at the behaviors in which people are engaged.  Some may be problematic. Others may be a skill we want to increase such as communication.  The objective is to maximize opportunities for positive growth.”

She goes further to describe how ABA helped Mia Smith adopt a behavior necessary for her safety and social development. “We designed a program to help Mia recognize and respond to a voice.  She was interested in several things.  But, if she was engaged in something, a movie or some other media on her mobile tablet, even if one of her favorite people said her name, she didn’t turn to look at them."

Part 2:  Kari’s shares her experiences in public schools.  Now, she uses these insights to aid parents and their kids with IEP meetings and other discussions with educators.  

Though Kari has moved to another company that doesn’t work with Mia day to day, she remains close to the Smiths.  Her experience with autistic kids allows her to be a friend and a resource, especially now that Mia is in school.   Any parent facing a meeting regarding an Individualized Educational Program, IEP, knows that it can be a stressful experience both for the parents and school.  Kari has worked on both sides of the table.  She often accompanies parents to the IEP meeting; however, she has experience working the in public school systems as well.   

“There are big challenges.  My role was organizational behavioral management, doing staff training in two school districts.  We worked closely with the special education director.  The school systems paid for contracted Behavioral Analysts to be deployed in schools.  Working in classrooms with teachers and para-professionals was a rewarding experience.  I performed staff development especially on autism.  I taught teaching strategies that are most effective to support teaching kids with autism, wrote behavioral plans, and implemented behavioral plans. 

"From my experience, most times the staff that is hired to work with these kids have limited experience and training in providing effective teaching methods.  Parents are typically frustrated with the lack of progress and lack of needs being met.  ABA is the number-one evidence-based process, but the presence in public schools is small.  Insurance pushes for children to be integrated into public schools instead of one-on-one therapy.  It’s not the fault of the staff.  The resources for them just aren’t there.  This means that kids who have ABA get their hours cut and progress slows in social, communicative, and behavioral skills.  So, it gets frustrating for everyone: the parents, the kids, the educators, communication breaks down into a cycle that’s not good for anyone involved.

"The really great results of having a partnership with public schools, which is rare in the U.S., pre-kindergarten through high school teachers were inspired to get a Master’s Degree in Behavioral Analysis.  A lead teacher with an advanced Behavioral Analysis degree will be able to program treatments for kids in more effective ways.  They can become better at modifying instructional design to be more effective. 

“Multicultural training is important for us as well.  Not being aware of cultural differences for something as simple as eye contact may lead to false impressions.  It requires having as much communication as possible.  An immigrant may speak English but not understand to the level needed to communicate effectively on these types of issues.  We try to accommodate for that and get an interpreter to really work out the details of therapy and differences in what we would normally see as a target.  So, cultural difference, we program for that.  We respect the differences in behaviors in which a parent may or may not choose to encourage."

Our last discussion was about the recent law, Ava’s Law, passed as Georgia SB1, requiring insurers to cover some ABA expenses; “The policy or contract may limit coverage for applied behavior analysis to $35,000.00 per year.”  This is a significant accomplishment for many kids that need the therapy.  Hopefully, there is more in the works.

Kari commented, “If you are going to spread ABA therapies out for a year, it probably covers ten hours a week.  The recommended intervention for most early learners is forty hours per week.  For education, whether it is the first IEP or the tenth IEP a parent walks into, I plan to continue to advocate for kids with autism and other special needs kids in that environment.  When a school may push for one thing in which the data show that something else or something more stands to be a better outcome, that’s how I can help.  However, ABA can help all individuals with disabilities or without disabilities alike.  ABA is such a useful scientific tool and I would like to lead efforts to expand it uses.”

Here. Use My Hippo.

Guernsey

While looking at the referrals on the blog stats, I happened to see Guernsey.  It's a good thing to have your geography lessons brought back to you.  Thanks Guernsey for the visit and the reminder.
https://en.wikipedia.org/wiki/Guernsey

Say What?

"Others only saw Mia in a moment....  We just needed to be stricter and punish Mia for bad behavior.  They did not see a child who may sense and interpret things differently.  Do you really punish a child for throwing a toy across the room when the toy scared him or her?" -  Hope Comes in Pieces

Big Weekend - Big Firsts

Mia's Dress

Two big firsts for Mia, so  I stressed out a bit.  She was in a wedding this weekend.  This was the first time she has been part of a wedding party.  Even the word wedding became an issue.  She really didn't want to even hear it.

Second, we spent the night in a hotel.  She thought the hotel was fun until it was bedtime.  She kept asking to go home.  So, we all squished up and snuggled in bed with as many of the comforts of home as we could manage.

Her immune system is much healthier than it was even a year ago. We don't use industrial cleaners at home.  Hotels do and we were worried.  I rubbed her with essential oils as added protection. So far so good....

Mia and Applied Behavioral Analysis

Mia and Applied Behavioral Analysis, Part 1 of 2

With Kari Porter, MS, BCBA

By Alford Kerry Hardy

Kari Porter is one of the Board Certified Behavioral Analyst, BCBA, who helped with Mia during the timespan of Hope Comes in Pieces.  Kari represents one those persons who held a piece of the puzzle.  She helped develop a better picture of what is required for Mia to recover from the regression she suffered.

She is from Illinois.  She earned her Master of Science in Behavior Analysis and Therapy from Southern Illinois University.  As it turned out, we have a common associate, Jonathan C. Baker, PhD., BCBA-D, Faculty Specialist, Autism Center of Excellence, Western Michigan University.  She worked with him on Project 12 Ways when was an associate professor at Southern Illinois University.  I met him while working on a latency-based assessment project.

BCBAs, like Kari, designed and modified Mia’s developmental programs.  She looked specifically at Mia’s data to determine if there was progress toward the written targets.  If Mia made satisfactory progress according to the expectation, Kari usually kept the program the same.   If Mia didn’t progress, Kari was responsible for recommending modifications to improve outcomes. 

She coordinated Mia’s care with the team of therapists from different disciplines that came into the Smith’s home.  The behavioral therapist was educated in a specific approach called Applied Behavioral Analysis, ABA.  Kari managed and designed Mia’s program.  The ABA therapist carried out what Kari assigned.  All of the activities were recorded on charts and worksheets.  Volumes of data were generated and reported quarterly.  She met with Craig and Terra to review Mia’s progress.  She made recommendations based on Mia’s trends, other comparative data, and the ABA therapist observations, all pointing to what worked and what did not.  This is known as evidence-based practices.  Decisions were made using the evidence-base for what worked for Mia and, most importantly, Craig’s and Terra’s overall plan for Mia’s recovery.  

Kari describes ABA as, “… looking at the behaviors in which people are engaged.  Some may be problematic.  Others may be a skill we want to increase such as communication.  The objective is to maximize opportunities for positive growth.”

Hope Comes in Pieces required going into these very detailed charts, graphs, and worksheets.  Terra gave me advanced warning when I asked her for them.  Even though she told me, it took the data coming over for me to grasp how much data one little girl generated.  And this was just behavioral data for a year.  The medical and genetic data was a whole other matter.   Then, I thought about it.  Someone collected data on Mia nearly every day.  If Mia went potty, someone recorded what she did and how she did it.  If Mia went into a tantrum, the event was recorded: what happened, when it happened, how long it lasted, and what triggered it.

After going through the files, Terra would tell me of the story behind all the numbers and descriptive language in the reports.  The sheer amount of data can be overwhelming.  Kari recommends, “Parents should research and understand the importance of ABA.”  Her hope is that by understanding how ABA fits into their child’s overall treatment, parents will understand how important it is to take the time to read and understand the reports.

She goes further to give a glimpse into one daily therapy with Mia to encourage a behavior.  Keep in mind that this is one of many targets occurring simultaneously. “Typically, a toddler will smile and recognize a parent entering into a room.  The child will understand familiar voices.  Mia was not doing any of these things at the age of the three. 

“We designed a program to help Mia recognize and respond to a voice.  She was interested in several things.  But, if she was engaged in something, a movie or some other media on her mobile tablet, even if one of her favorite people said her name,  she didn’t turn to look at them."  Simply taking the tablet was not an answer nor would it address the behavioral issue.  It may have made adopting a different behavior even harder.

"She would not respond as if, I hear Mom’s voice where is Mom.  We worked a lot on recognizing when people were talking to her. The task was to get her to respond when called from a distance, out of her sight.  We started out with the therapist voice then brought in Terra to help with the transition from responding to the therapist to responding to Terra.

“Terra worked away from home at the time. She came home for lunch to help with the transition.  In the evenings, prior to the end of therapy, she helped again.  Also, we needed to transfer that over to Craig and Mia’s grandpa, who lives with them.  Mia picks up some things quickly.  Adopting a behavior like this particular one though, took hundreds of trials over months. 

1. We started right in front of her then slowly moved away
2. Each time she turned and looked, we provided verbal and physical reinforcements.  Mia likes ice chips so we gave to her those as well
3. Overtime, we slowly built on small successful responses to her name being called until she adopted the behavior"

Read Part 2 of 2

A Bit of a Meltdown