ABA Unfiltered
ABA Unfiltered
ABA Unfiltered Season 5 Episode 10- Continued Evolution of Compassionate Care in ABA
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The podcast hosts BlueSprig's Chief Clinical and Administrative Officer, Sharyn Kerr, to discuss the importance and continued evolution of compassionate care in applied behavior analysis. Join us on our journey to learn more about the field of ABA!
Check out our CEU site for the Episode promo code: https://bcbaceu.bluesprigautism.com/
Hello everyone, this is Andrew Blumstrom along with Amanda Fulbright, and you are listening to ABA Unfiltered, where each episode we interview guests from around the world of ABA. Whether you're a BCBA, RBT, or just interested in ABA, you are sure to pick up some actionable advice you can utilize on your journey. Without further ado, I would like to welcome on our guest, Sharon Kerr, the Chief Clinical and Administrative Officer at Blue Spring Pediatrics. Sharon, why don't you go and tell us a little bit about yourself?
SPEAKER_02Thank you, Andrew, and thank you for having me. Yeah, my name is Sharon Kerr. I'm uh currently the Chief Clinical and Administrative Officer at Blue Sprig, which means that I oversee the clinical vision of the company as well as overseeing a lot of back-end functions that support our clinical services, things like marketing and compliance. I started my journey in this field about 25 years ago, working as an RBT before there was such a thing as an RBT, and kind of worked my way up to supervisor, director, et cetera. At the same time, I was also getting my psychology degree. So I'm a licensed psychologist. And then as my career progressed, I ended up doing more operational work, which you know a lot of uh BCBAs who have been in the field for some time tend to do. And so, in the spirit of you know, ongoing learning and wanting to do things well, I kind of went back to school and got my MBA. So uh I wear multiple hats and enjoy every second of it.
SPEAKER_00Well, awesome. We're happy to have you.
SPEAKER_01Sharon, don't you feel too young to say that you've been in the field for 25 years?
SPEAKER_02Um, you know what? Depends on the day. Sometimes I feel too young, sometimes I feel too old.
SPEAKER_01I hear you on that. So thank you for joining us. Thanks for coming on. Um, we want to talk about compassionate care in ABA today. It's something you and I have had conversations about um for the last couple of years or or more, um more probably, because one of our values at Blue Sprig is being compassionate and passionate. And so it's right there baked into our values. So when we say or you say compassionate care, what does that mean exactly?
SPEAKER_02Yeah, it's a great question. I'll say when I started in the field um many years ago, uh, it was it was about teaching and it was about compliance. Like how could we teach these kids and get them to learn all the things that they need to learn? And as my career has progressed, I've seen the field progress and I've seen us uh shift to more of a um an appreciation for compassion over compliance and a shift from maybe from teaching to learning. And and so I think where um when I think about you know compassionate care and what does that mean, I think it's focused on the individual that we're working with. For us, it's it's the children that we work with. And I think it's how can we uh get to a place where we are treating them with compassion, treating them with dignity, treating them with respect to get them in a place where not only are they learning, um, but they love learning. And it's not necessarily focused just on compliance.
SPEAKER_00Awesome. And, you know, to kind of piggyback on that, you know, as you mentioned, the industry is changing. And we've definitely heard the word, you know, the term compassionate care used a lot more over the past two years. Would you say that this is more of like a buzzword, or do you see it more as a movement in the industry uh moving to a new way of care?
SPEAKER_02I think it's a movement in the industry. And the reason I say I think it's a movement is if you look at other medical fields that have existed a long time before us, you know, I teach an ethics class and I often say the ABA field is still in its infancy. So as long as you know we've been around, it's still in its infancy compared to other medical uh professions. And so I think when you look at a lot of those other medical professions and you think about their trajectory and what they learned and where they're at today, compassionate care is nothing new. Um, while it may seem new in the ABA world, um, it's certainly not new in the medical field. And so I think if you kind of take a look at what's happening in other medical professions and you see the benefit of compassionate care in terms of patient well-being, patient outcomes, I do think it's a movement. And uh I think it's growing in steam, which I think is a is a good thing for for us as professionals, certainly a good thing for our clients, and ultimately I think it'll be a really good thing for our profession. Yeah.
SPEAKER_00Um how can you see this being extraordinarily important for the world of ABA?
SPEAKER_02Well, I think it kind of goes back to the comment I made about you know, a lot of um uh historically, a lot of the programs, uh whether it's um university programs, training programs, um, in-house programs, have been around compliance. And I think that taking the shift away from compliance and onto compassion, I think it opens up a new way of teaching. I think it opens up a new philosophy around what's important when it comes to client outcomes. And I know client outcomes is a big topic for our field. It has been for a number of years, and I think we're struggling with the concept of clinical outcomes. You know, how do we define it? Once we define it, uh, and that's a big, you know, you know, if there, because I think there's a lot of different points of view around what is um what is a clinical uh quality outcome. But once you get agreement on defining it, how do you measure it? And then how do you attain it? Which I think for for us in the field that are you know working with kids every day, the application of those definitions and those concepts is really important. And I think that's where compassionate care comes into that conversation, because I don't think that you can have a conversation around outcomes without thinking about compassionate care.
SPEAKER_00Awesome. I agree. Thank you.
SPEAKER_01Karen, you you and I both are BCBAs, but you also are a licensed psychologist, uh, which I am not. So can you talk to us a little bit about like your training in psychology and an ongoing training in psychology? And is this something that is taught in in those programs and in those um like internships and things like that, in that part of your background?
SPEAKER_02Yeah, it's a great question. And again, I've had my psychology degree and license for a number of years, so I'm going back a fair way. Um, but but it's definitely more part of the program than it is, you know, um, compared to ABA programs. And I remember in the early days, because I was actually a clinical psychologist before I was a BCBA. And so in the early days, I was almost embarrassed to tell people that I was a clinical psychologist because it meant that I couldn't truly be a BCBA because um I wasn't just looking at observable behaviors in front of me. I was thinking about internal thoughts and feelings, and it was this weird dynamic. And I remember being in places with different people having conversations where I would almost be embarrassed to kind of talk about the fact that I had that degree. And I I'm no longer embarrassed to talk about it. So I think that in itself just shows that we have progressed as a field. Uh, but yeah, I think that when I went through my early studies, it's a huge part of it. Um, you know, really thinking about the client in terms of where they're at, what they want, how they uh where they want to be and how they want to get there, and really incorporating the client into the treatment planning and and decision-making process was was huge. So, you know, if a client um had a preference for a certain type of treatment, that was a factor that was considered when designing a treatment plan. Now, obviously, there's there's um kind of guide uh guidelines around that in terms of practicing evidence-based care, but if there were a couple of different ways to approach a client and the problem that they were coming to you with, you would incorporate the client's point of view and and what they're wanting. And I think we're starting to see that shift a little bit with ABA, where we didn't have that before. We said, this is the program and this is the way we do it. And if a child was pushing back in a therapy session, or if a parent was pushing back, it was they're non-compliant and we need to get adherence to the program. So I think my background and training as a psychologist has actually helped shape me as a VCBA and and helped me in terms of the concept of compassionate care is not such a foreign and unique concept. And it to me it's it's we can merge these two worlds quite easily.
SPEAKER_01It's surprising to me when I've I've had some conversations with folks that that have thought that this was a buzzword or a but, you know, just kind of the flavor of the year, the flavor of the, you know, a couple of years from like that's concerning for me. Like compassion shouldn't be a buzzword, right? Shouldn't we always approach our clients with compassion?
SPEAKER_02Yeah, and and look, it's in our code of ethics, right? Like one of the core principles is that we are treating others with compassion. So, and I think that that was um a real big step for our field to have that be part of the updated ethics code. So, yeah, it it should not be a buzzword. I think if people are thinking it's a buzzword, they kind of miss the point. Um, I think it's something that I we've kind of talked about this. There's there's some people out there that criticize our field, and I think that some of those criticisms are fair, but I think like any field, any profession, you grow and you learn and you evolve over time. And so I think it's important for us to understand some of the criticisms and learn and grow from that. And I think that criticisms around the lack of compassion um for some of our early days, you know, uh early ABA was completely fair. It completely fair. And I think if we're gonna evolve and survive as a field, we need to be able to make sure that new BCBAs coming through are trained in compassionate care, what that means, how to deliver it. Um, because I think if we thought of it as a buzzword, that's something that's gonna come and go really quickly, it's gonna be a problem for us longer term.
SPEAKER_01Right, right. So you you touched on you know university programs, you've kind of touched on teaching newer BCBAs and stuff. So you kind of stole my thunder there a little bit with the question, but I wouldn't go ahead and ask it in case there's any more you have. No, it's all good. Um, but uh Bridget Taylor talked about in in an article in 2018, which was about five years ago now, um, and described compassionate care as involving interpersonal skills uh related to sympathy, empathy, and compassion. Um, do you think, I mean, you you teach at a program right now, um, but do you think that that's generally being taught in practice in university programs? I can tell you, you know, it wasn't when I was there. What do you what are you seeing today?
SPEAKER_02Yeah, and it wasn't for me either. I would say that because of its addition to the ethics code, it's probably been taught a little bit more than what it was many years ago. But I think it's probably more surface level. Um and I say that not as a criticism to the programs out there. The task list is pretty exhaustive. There's a lot on there, and there's a lot of complicated concepts on there, and there's only so many hours, you know, that you get to teach all of those things. So I think that while we're maybe teaching it more than what we have in the past, I think it's probably not to the level that is required. And it's something that I would love to see moving forward, is there be more of an emphasis on that? Because I really do think that if you can teach these skills early on in the program, it you'll have better clinicians coming out of those programs. And if you've got better clinicians, you've got better treatment plans and you've got you know better outcomes. Um, but but yeah, it's you know, when I think about it compared to maybe some of my psychology classes, it's very different, very surface level. But, you know, I I think this is maybe just the start of the movement and we've got time.
SPEAKER_01Do you think it's the responsibility of programs, like university programs, certification programs, or supervisors and organizations that you know provide supervision, or is that a collaborative effort?
SPEAKER_02I think it's a collaborative effort. I think it's really hard to teach the concept of compassionate care in a class, especially classes that are maybe online, which a lot of classes are online today. Um I think that really where you're going to learn it is through your supervised work. Because it does involve interpersonal relationships. And so it's hard to kind of teach that on like a Zoom call. I think the catch 22 though is if you are expecting your supervisor to teach you those skills, and that supervisor hasn't been taught those skills either in their program or by their you know previous or current supervisors, it's it's I hate to say it, but we might have a situation of the blind leading the blind. So I do think it's collaborative. I do think we need to really think about how we can more effectively teach it in our programs. But I do think that we need to provide more support for our existing clinicians and our supervising um clinicians so that they can offer that kind of in-depth training and support that our new BCBAs and our trainees and supervisees need in the field.
SPEAKER_01So maybe more ongoing continuing education and professional development opportunities as well.
SPEAKER_02Definitely. And you know, you know, we were at CASP a couple of weeks ago, and I went to, you know, a few of the sessions that were around compassionate care. So I know it's out there. Um, it's not that it's hard to hard to find. Uh, so I would encourage anyone, you know, any BCBA that's kind of listening to this podcast to kind of really think about what does compassionate care mean to me? What is my understanding of it today, and and maybe where where would I want to be as a clinician in the future and seek out some of those learning opportunities, whether it's CEU courses that are available or having that conversation with you know your supervisors at your place of work.
SPEAKER_01Awesome. Very cool. Thank you for that suggestion as well. What do you think some ways that BCBAs who are out there practicing or organizations with with many BCBAs can practice more compassionate care? Like what are some actionable steps?
SPEAKER_02It's a great question. I I think it's it can be hard to kind of tackle this topic alone. So I do like the idea of of it kind of almost being like an organizational um initiative. Uh I think it's much easier to do. I think BCBAs out there know that uh there aren't enough hours in the day and there are way too many kids to to see. And so there's a lot of pressure on BCBAs to be everywhere and do everything all at once. And one of the things I worry about with that is a lot of the work of a BCBA becomes a check the box activity. Have I seen that client? Have I overlapped with that RBT? Have I written that treatment plan? And they're they're checking boxes. And so there's not a lot of room for kind of that professional development as it relates to compassionate care. And I think that's where the organization comes in. I think if you work at an organization that values growth and evolution in terms of, you know, this is where we were as an AVA field, and it's great, but we know we can do better and continue to do better and give people time. Yeah, we've talked a lot about creating that um culture of continuous learning. It's a new skill for a lot of people. You can't just say, hey, I want you to do more compassionate care. I'm like, like, what is that? What does that mean? You need to, you need to, at an organizational level, make that a priority and provide growth opportunities, learning opportunities for staff. I also think that from an organizational point of view, really thinking about the policies that the company has, the procedures that the company has, that impacts your ability to engage in compassionate care. So, if, for example, if you have a policy that says, you know, you exit clients that cancel, you know, uh, or um discharge a client after three cancellations, like that can be um counterintuitive to providing compassionate care. If you have a policy that says if a family is um engaging in a high level of cancellations or no shows, you have maybe a clinical director that meets with the parents to understand, you know, what their limitations are, maybe things that they're going through, and then work collaboratively with them to find a schedule that works for them and works for the organization and the RBTs. I mean, we also know that we have a shortage of RBTs. So we don't want to train and have great RBTs that then quit because they get cancelled on, you know. So, you know, there are two sides to that story. But if you create a policy that demonstrates that we want to work with our clients and we want to understand our clients, understand where they're coming from, and we want to work collaboratively on solutions to any problems that we may be having, that helps. Um, so I do think that if an organization truly wants to engage in compassionate care, there has to be organizational um initiatives that have kind of created built in to be able to encourage that at every level of the organization.
SPEAKER_01What I'm hearing you describe is in most of the things that you've said, is this power dynamic, if you will, in the relationship. And I feel like the compliance, like you were talking about earlier, it's very much a I'm in charge or we're in charge, and and you need to adhere versus a compassionate approach being like we're on this journey together, we're in a partnership, we're walking side by side. There is no one with with the power, if you will. And if there is, it's probably the the client, right? Should be yes, I I hadn't really thought about it like that.
SPEAKER_02But yeah, I, you know, I used to talk a lot about parents as partners. You know, we as clinicians may be an expert in ABA autism, but parents are the experts in their their children. They know their children better than anyone and they will be with their children um the longest, longer than than us as clinicians. And so really collaborating. uh with with parents but i think it's also clients as partners and if it doesn't matter that they're minors um you know they're along uh along with us in this this journey and and so i do think that if if a clinician is going in with that kind of power um uh differential mentality then it can be really really hard it can be really hard to to truly develop um a therapeutic approach that truly is compassionate because that interpersonal aspect of treatment is is really important and if you're coming in i'm the expert and i need to do all these things check the box and then leave i i don't see how that how you could get to that place not easily yeah so we we've been talking about it's a really important skill for behavior analysts to have but we haven't really mentioned RBTs in this conversation but as we know our RBTs are with the clients far more than the BCBAs typically are so this is a skill that we probably need to be thinking about teaching them as well and a concept that we need to be teaching them as well. Yes and it's tricky I remember the first time I was working with a child I was kind of lucky I started out as a volunteer so I basically shadowed someone for three months um unpaid but I it was the best thing that I ever did because I was able to truly learn how to do um certain things and probably more importantly why like why to do things like and and and I think for a lot of RBTs today um they go through a fairly comprehensive training and some training programs are better than others. Some organizations you know do that initial new high training better than others but um it's still a fairly short training program considering all the work that they have to do. And so it is scary for RBTs going in there. And if you're coming from a place of compliance and you've given an instruction to a child and they're noncompliant and then you try to you know implement the things that you were taught and it doesn't work, it's like oh it's stressful. It's very stressful. And so it's not only I guess compassionate care for the client but it's also compassionate um care for our for our RBTs. And so I I think that one of the things I like about a compassionate care approach is the emphasis is on the client the relationship between the client and the RBT. And so if it's not just you know going through the data book, picking a goal looking at the protocol implementing it and kind of working through until you get compliance. So I I do think it's a skill that does need to be taught to RBTs. And I think it's maybe a little bit more of a messier skill compared to you know skills around getting compliance but I think it's it's a much um I think it's much more enjoyable for our RBTs if if they're going in with the thought of we want you to have fun with this client because when you're having fun and the client's having fun the client will learn and everyone will will you know instead of a 20 minute tantrum you get you know 50 you know learning units happening. So I I do think it's a different way of teaching RBTs and I think it's a more enjoyable way for RBTs to work. But it is it's a different approach and it does need to be taught to RBTs. Thanks for that.
SPEAKER_00Yeah. So you've kind of hinted at this throughout our conversation um you know the field of ABA is still fairly young and there has been criticism in the past about certain things that used to be done what do you think some of the risks are for the field if all clinicians don't kind of start to implement the practice of compassionate care question I I think that as an organization or I should say as a profession the risk to us to us as as a profession is people not seeing the benefit of what we do or not seeing that the benefit is worth it.
SPEAKER_02And I think that's a problem. And you know one of the things that I do with my my students is is I say you know part of our ethical responsibility is to disseminate the science. And I'll often say if you said to someone I'm a BCBA would they know what that meant and it's usually like no probably not and so one of the things we do is we come up with an your elevator pitch. You know pretend that you've graduated you're a BCBA you're in an elevator and someone says oh what do you do? Create that in a way that's meaningful and understood by lay people. And so I just think that a lot of people don't understand what it is we do. You could say I'm a doctor I'm a chiropractor I'm a dentist I'm a whatever people instantly know what that is. We're not there yet we are not there yet and if we don't do a better job of evolving and and creating a profession that really provides high quality services in a compassionate way that is well received by the community we risk uh losing our profession before we've really become fully established um so I think that's that's the risk. At the same time just like any other profession no one's going to be perfect at this some people will do it better than others. I do think we need more research around it specific there's a lot of research on compassionate care and wellbeing but I think we could probably have more research with compassionate care in the ABA field. So I think that there's there's more learning to be done. But but yeah I I don't think everyone has to do it. I don't think we have to be perfect at it but I think we have to to your early question about is this like a a buzzword or a movement I think we have to take it as a movement and we have to all be working together to continue that that movement forward.
SPEAKER_00Beautiful and I agree.
SPEAKER_01Yeah Karen I had my first experience uh just last week of giving my elevator speech to somebody and and they said are you a BCBA? I was like I love it you know what that is awesome so I guess my elevator speech was was good enough that they knew what I was talking about.
SPEAKER_02So look I will actually say that there have been a few occasions where I will say I'm a BCBA and I'm about to explain what that means and they're like oh yeah my such and such my sister and so we're getting there we are getting there which is which is really exciting.
SPEAKER_01Awesome very cool well thank you for talking to us about compassionate care. I hope that uh folks will continue to learn and grow in this area and and this is just you know one small step the having the conversations right yeah you know what it's a good point it's you have to start somewhere and just the fact that we're having a conversation about it it's meaningful.
SPEAKER_00Yes I agree so thank you for being a conduit to to having conversations Sharon but we're not done will you play question of the week with us yes I will excellent excellent so we've got three questions for you for questions of the week two questions are um questions we ask to all of our guests and then the third one we'll open up the wheel and it'll be the true wildcard question and we'll kind of let fate decide what your third question is. All right the first question we'd like to ask uh you know as you know Amanda and I are part of the learning and performance development department so we love to learn what others are learning.
SPEAKER_02So if you don't mind um could you tell us something that you've learned lately doesn't have to be related to ABA just in general what's something that you have learned or in the process of learning um well a very um insignificant thing I learned just the other day was that the edging of a Ritz cracker is apparently a knife to cut slices of cheese I'm like no so I'm like that was that was interesting on a more significant level I'm I'm actually um reading Adam Grant's latest book um because I'm trying to learn a lot more about change management. I think you know people always say change is hard and I'm like does it really have to be hard and is there a way that we can grow as people grow as professionals and and really understand why change might be hard and how we can make it easier for ourselves. So it's a really um Adam Grant's one of my my favorite speakers and authors so I'm learning a lot there.
SPEAKER_01Awesome I have to go back to the roots crackers in my cupboard with some cheese and I'm gonna definitely be that as soon as I haven't tried it I was just told this same Andrew same uh we just had uh that yesterday a snack and I'm like no way that can be a knife but we're gonna try it and we'll at least try it you know okay now we're learning things so next question so you know let's say today instead of 24 hours you've got 25 so you find yourself with an extra hour in the day how would you spend your extra hour really good question so I have a really long list of things to do and I have people saying hey have you finished that yet so probably if I'm being super honest I would get through my things to do list but I would say that once I got through my things to do list I would um I would you know spend the hour with my with my family my my kids are like 12 and 15 so it's I'm getting to that point of oh my gosh they're gonna be leaving in a few years going to college my time is limited so I'm uh wanting to kind of cherish all of those those moments that I have with my kids before they go off into the world.
SPEAKER_00No very nice thank you for sharing are you ready for the last and final wild card question? No but let's do it anyway all right here so let me uh go ahead and I'm gonna go ahead and share my screen in a moment um once I share my screen you will see a wheel in front of you all right can you see the wheel on my screen I can see the wheel awesome in a second I'm gonna go ahead and hit the play button um once I hit play whenever you are ready go ahead and tell me to stop uh it'll stop on one of those numbers one through 12. Each one of those numbers corresponds to a question in front of me and then whichever number uh it lands on will be the question that we end up asking you for the third and final wild card question. Are you ready?
SPEAKER_02I'm ready.
SPEAKER_00All right so when I'm gonna go ahead and hit play and just let me know when you would like me to stop and stop question seven.
SPEAKER_02Ooh unlucky seven okay lucky seven this is not too bad.
SPEAKER_01Uh if you could tell us a little bit about your first job oh my first job was actually delivering the newspaper um I was like really wanting to do something and earn money and at my age the only thing I could do was deliver the newspaper so I have a vivid recollection of getting up at like 5 a.m in the morning it was like raining and having to deliver the newspaper before school started so every job after that has been fantastic can only go up it can only go up it can only go up did you ride a bike no no I I walked it made it worse but I had good calf muscles though I mean you know I guess I can't complain nice very cool love that well Sharon thank you so much for joining us uh I know you're busy and you know you just said you had so much on your to-do list but you still took some time out of your day to hang out with us and we really appreciate it. It was a pleasure it was a really important topic. I appreciate being invited on well thank you.
SPEAKER_00Well thank you so much Sharon until next time see you soon bye y'all bye if you or someone you know is looking for some CEUs head over to BCBAceu.blue sprigautism dot com and use the promo code podcast to get five dollars off any CEU in the catalog. A link to the site can be found below in the description thanks again for tuning in and we'll see you next time