Upgrading Your ABA Intake Interviews: Staff Skills, Systems, and Clinical Decisions with Dr. Kristen Byra

Podcast Episode: Upgrading Your ABA Intake Interviews: Staff Skills, Systems, and Clinical Decisions with Dr. Kristen Byra

In this episode of In the Field: The ABA Podcast, I sit down with Dr. Kristen Byra, seasoned clinician and founder of Upskill ABA, to dig into one of the most critical—and often overlooked—components of clinical practice: the intake assessment. Kristen shares how standardizing this process through decision models can improve both clinical outcomes and staff performance, while still honoring clinical judgment and caregiver input.

We explore how decision models support newer and experienced BCBAs alike, how they can reduce burnout by eliminating guesswork, and how they build stronger, more meaningful caregiver interviews that go beyond surface-level questions.

Key Topics:

• What Makes a Quality Intake Assessment: Kristen shares what’s often missing from our assessments and how to design interviews that lead to better treatment plans and more meaningful caregiver involvement.
• Decision Models 101: What they are, how they differ from decision trees, and how they can support—but not replace—clinical judgment.
• Bridging Research and Practice: We talk through the challenges BCBAs face in accessing and applying literature, and how tools like decision models bring curated resources and practical guides to the front lines of care.
• Training Through Tools: Kristen explains how decision models double as a training tool for newer BCBAs by prompting deeper thinking and standardizing high-quality practices.
• Caregiver Interviews with Purpose: From asking the right questions to respecting caregiver time and building rapport, we dive into strategies to gather accurate, actionable data that’s aligned with caregiver priorities.
• Scope, Fit, and Clinical Judgment: We discuss how assessments can help determine organizational fit, when to refer out, and how to avoid unintentionally overpromising services.

Key Takeaways:

• Great assessments go beyond checklists. They require intentional questions, empathy, and a clear link to treatment planning.
• Decision models can reduce variability across assessors and provide a knowledge base that supports training and quality improvement.
• Clinical judgment is enhanced—not replaced—by well-designed tools that prompt deeper consideration and offer actionable next steps.
• BCBAs must balance standardization and flexibility while prioritizing caregiver input and values.
• Refusing services when there’s a misalignment isn’t just okay—it’s ethical. But how we do it matters.

Keywords: ABA Intake Assessment, Clinical Decision Model, Supervision, ABA Tools, Caregiver Interview, Standardized Assessment, ABA Treatment Planning, Social Validity, Kristen Byra, Upskill ABA, Applied Behavior Analysis

Connect with Kristen:

• Website: www.upskillaba.com
• LinkedIn: Kristen Byra
• Beta Access: Interested in beta testing the Intake Interview Decision Model? Visit her site or connect via LinkedIn to participate.

Subscribe to the Podcast: Don’t forget to subscribe to In the Field: The ABA Podcast for more insights and interviews with experts in behavior analysis. Visit www.sidekicklearning.net for more resources on fieldwork supervision and continuing education opportunities!

Disclaimer:

BCBA®, BACB® [or any other BACB® trademark used] is/are registered to the Behavior Analytic Certification Board® BACB®. This website and products are not in any way sponsored by the BACB®.

All information and products are for educational purposes only.

Transcript

Welcome to In The Field, The ABA Podcast. I'm your host, Allyson Wharam, creator of Sidekick, an online interactive curriculum and learning portal for behavior analysts. We specialize in providing a field work, supervision curriculum and continuing education for ABA professionals. In this podcast, we're going to deep dive into the world of ABA focusing on quality supervision as the foundation of our field.

We're here for behavior analysts, business leaders and trainees who are passionate about maximizing outcomes for their clients and improving the quality of their services with new and innovative practices. We're going to explore effective strategies and practices that not only enhance the quality of supervision, but also save time all while investing in the people who make up our field, our clients, our trainees, and your everyday behavior analysts.

So whether you're driving to your next in-home session or taking a break from your busy schedule, let's dive right in.

Allyson Wharam: Hi everyone. Welcome. I'm here with Kristen Byra of Upskill ABA and today we're going to be talking about assessments, particularly intake assessments and how we might use technology in that process to enhance the skills of the people conducting the assessments.

We'll also dive into just some of the nitty gritty details of what an intake assessment should entail, some of those assessment skills, so that as you are training and supporting other people with this process, you can do that effectively. Kristen, why don't you go ahead and tell us a little bit about yourself, the work that you're doing at Upskill ABA and why this is particularly relevant right now.

Kristen Byra: Sure. Thanks for having me, first and foremost. It's nice to be able to chat with folks in the field about what I'm up to. I'll try and do a real brief overview of my experience. I did the very traditional BCBA route back when I first started and I got my master's and PhD at Western Michigan University.

And Then I did, school consultation and home based services and then center based services. I'll be [00:02:00] certified 18 years in August, so it seems like a very long time. 

Allyson Wharam: What's your number? 

Kristen Byra: Yeah, so 35 23 like there was, 3,500 BCBAs when I started. There's now I don't know what it, like 76,000 or something like that or close to.

So yeah, I've spent and dedicated more than, half my life to this field. So it's something I've been and continue to be really passionate about. And I wanna make sure as we continue this exponential growth that we are really making sure that we are supporting those who are new in our field so that our clients are then obviously getting the benefits of that kind of quality. 

Allyson Wharam: When you say traditional route, traditional in terms of what's common or the norm now is very different from traditional then, in terms of in-person programs and specifically getting a PhD and things like that. Yeah you're doing a lot of work right now with ABA organizations and clinical tools to help them elevate the quality of their care based on your experience and the research. So talk to me a little bit about that and some of the tools [00:03:00] and things that you're creating right now.

Kristen Byra: Sure. Yeah. So I guess I also meant traditional in the fact that I had a caseload and I had, practicum students under me. They weren't even RBT's at the time. But about nine years ago is when I transitioned into making clinical decision models in clinical intelligence forms. And I see that huge disconnect between the opportunities I had, and I wanna make that more accessible to more people.

I think we can only do that if we start standardizing our approach a little bit more. There's barriers for all of us to be able to do things like a literature review. Last time I checked, there's no CPT code that says, oh, spend an hour researching the internet for good articles about this problem.

I'm gonna go bill for that. So I know there's barriers to that because there's competing contingencies. I did a CE this morning and I asked folks in the audience like, how many of you have a bonus tied to your billables? And almost all of them said yes that tons of them do. So I understand there's a huge competing contingency of, do I wanna do this activity that is really [00:04:00] laborist and labor intensive. And there may be a paywall like behind it, right? So it's. I see this abstract. It sounds good. Do I really wanna spend 40 bucks to get an article that may or may not be great? And it's, a really long time for me to go through and find the relevant article.

Or maybe I get through it and it's something I don't feel like I can implement in the clinic-based setting or home-based setting that I'm on. And so now I've just gone three hours down a rabbit hole and I'm no better off than where I started and now I've missed out on my bonus. So the whole intention behind decision models is to bring those kind of curated resources to clinicians to help solve the problems in addition to articles.

Because articles can be great, but can be difficult to translate a published article or where you have, a really dedicated grad student who's wanting to publish your dissertation with a bunch of lab assistants to get that to fruition and then try and implement it into your clinic may be really challenging.

So you're also gonna get access to things like job aids and checklists to also help you samples of, "Hey, it may not be exactly like this, but here's a template to [00:05:00] go off of," so that you can go and do those things yourself.

Allyson Wharam: Even if you have the time or the skills or the resources to find the articles if you're strapped for time, like you said. At the end of the day, it might not even translate. Matt was on the podcast and we talked about reading research, and you just spend all this time and then all of a sudden you realize that you've wasted it because it's actually not applicable once you get down to the details.

So I love that, that it is really focused on making things as practical as possible. How do you do that within a decision model though? Talk me through that. If I don't know what a decision model is, how do you define that and what does that actually look like in practice?

Kristen Byra: So I'll start off, what is a decision, right? What is even a decision going at that kind of basic level? And it really is just a commitment to some kind of action. And we make decisions all day, every day. What am I gonna wear today? What am I going to have for breakfast? What route am I gonna take to work if I'm driving somewhere?

But then with our clients, we're making tons of decisions all of the time about treatment planning, whether it's skill positions, behavior reduction, how am I gonna approach a [00:06:00] caregiver with a particular problem or goal that I'm working on? And so I'm making some kind of commitment to some course of action.

But as we do that, we go through a process, right? So we identify that there's a problem. Then we're trying to come up with solutions to those problems and then we start making some determination based on things like, do I know how to do this? What's the budget for doing something like this? How much time and energy is it gonna be for me to train my RBT to do these things?

Are parents gonna be bought in? And it goes through that process of determining that kind of next course of action I commit to and then implement it. It's kind of that decision making process. When we do that with something like a decision tree, which sometimes people get confused that those are synonymous when they're not.

A decision tree is very binary. So it's if this, then that if no go left, if yes go right, and it brings you to an end point. With decision modeling, you don't just have one pathway, you can start integrating multiple variables into that path. And so if this, plus this other thing over here, oh, and don't forget, we also asked about this variable. [00:07:00] Those things can all start tying together to give you the kind of that directional action plan. And not all of it is you have to do this. Actually none of it is you have to, all of it is, here's a suggestion, here's an actionable statement that you can either choose to act on or not.

Decision models are not replacing clinical judgment. I think sometimes folks panic a little bit when they hear that, oh, it's gonna take over my job as a clinician. I don't have autonomy anymore. This is no longer what I wanna do. It's not my belief system, or I'm not living my values.

It's really not that. It is supplementing your decision making skills. It is not replacing or supplanting them. It's helping you make more informed decisions. So at the end of the day, it's still you who are building the treatment plan. It's still you who are deriving the goals. It's just helping you make a better informed decision as you go through those processes of what should I do next?

Allyson Wharam: I think about this a lot in the context of supervision as well. That, there's so many different options and walking through all of the different variables it's very complex to even think about. And so I wonder how do you [00:08:00] see decision models coming into play for it? Like a brand new clinician who is still just learning versus maybe a more experienced clinician.

Talk me through that and how it might differ based on where someone is in their career. 

Kristen Byra: If you read my LinkedIn, you're gonna see my tagline that I'm building for the 51% who have been certified for five years or less, but I will say that, I think at any point in your career, you are never gonna know everything. You best believe there is bunches of things that I do not know in this field or a type of client profile that I have not worked with.

So I would say anyone going through the models is probably gonna have a, huh, I didn't think of that. Oh, I never knew, or I didn't think to look at or find the, or here's how I didn't know I could apply this kind of moments. I think those moments are more frequent when there's someone who's a little bit fresher in the field, maybe didn't have the privilege of a really robust, coursework, practicum, and supervision opportunities that I've had in my career.

And so it does function as a knowledge management system. You will [00:09:00] be more informed and better prepared coming out of it. If you go through it right, it's gonna bring you through the, have you thought about. And what about this though? So the next time you go through it, it's like, oh, wait, I remember, I remember this one article, and I'm gonna apply that.

And so you don't always have to go back into the model every single time either depending on which model you're using, because you are gaining skills as you go through it.

Allyson Wharam: I was wondering about that, of the need to use it maybe every time or in every case if that differs across time. I think about, there are a lot of lovely flow charts for choosing which data collection method to use or which stimulus preference assessment to use, which are really handy and supervision.

But in general, like as a behavior analyst, once you're well trained or well versed in those things, you don't necessarily need to go to that flow chart, but it's necessary as that first step. And at the flip side like these are a lot more robust than a flow chart is. So they might be really handy for, again, thinking through some of those variables.

That's really interesting to think about how the use case might be a little bit different [00:10:00] depending on where someone is, and that it can really be almost a training tool, which is leading to what we're talking about a little bit more today in terms of the newest decision model that you've created is around initial assessments, specifically dealing with caregivers, stakeholders, doing those initial intake assessments.

And I know that for me that is one of the most difficult skills, those interviewing skills because it's so multifaceted. I think in terms of the interpersonal piece, knowing what to ask, knowing what variables are important knowing what the goal of your assessment is. If you don't have a great frame of what you're trying to understand based on this and how that leads to the goals that you're going to develop and the treatment plan and how you're going to conceptualize services. And you don't know what that looks like. You don't really know what to ask or what to dig into. And then again, like I said, you have the interpersonal skills, just simply managing the interview, making it comfortable knowing [00:11:00] how to interact with that caregiver. And so talk me through what a decision model looks like in assessment, and then let's talk through some of those different variables that come up in an intake assessment.

Kristen Byra: Sure. So the one that you're referencing it is in beta. So we're testing it right now. It's still open too, so if anyone listening is interested in participating, it's free. I know that sometimes beta is a cost or like a reduced cost, but it is free 'cause I don't want cost to be a barrier for folks to be able to contribute.

I am really passionate about clinical tools being built by clinicians. I'm only one clinician. I really wanna make sure the folks who are going to use the tool really have the opportunity to build something that they find really valuable. I may see it as I would use this or I'd use it in this way.

But I'm only one clinician and I wanna make sure I'm incorporating everyone's feedback into that. So this particular tool looks at the interview, the first interview you're gonna do with your caregivers as they're coming into service. When you're doing your first initial assessment, you're doing some observation with the client, like you're getting such a limited [00:12:00] window into a quick brief, like blink of eye snapshot of what this kiddo or young adult, depending on the age that you're working with, is really like, and you may have huge, observational impact.

This is not how they normally are because they're in a new place, especially if they're coming into a clinic. Or even if you're going to their home, who is this person? You may see a completely night and day kind of presentation to what they're normally like, but who knows them really well.

Their parents, their caregiver, whoever is doing their care 24 hours a day. They have a lot of information, but we have to know what to ask and more importantly, as you mentioned, like how to ask. And then once we get it, once we get that information, we best do something with it. I don't know how many times I've seen clinicians go through the process of asking all this information and then they do zero with it.

Why are we wasting the caregiver's time? If you've seen me run my mouth on LinkedIn, you may have seen me quote my old professor. And the quote is, the road to hell is paved with data you never look at. And so I'm a really strong believer if we are [00:13:00] gonna take caregivers really valuable time 'cause it is valuable and I'm not sure everyone who's maybe not worked in this field before or maybe is not a caregiver themselves, really understand the amount of pressure and time scarcity a caregiver of a child with special needs has.

And this two hour assessment, you're in your mind maybe thinking oh, is this two hours I've got a bill and I gotta do this other thing. Like the caregiver is thinking the same thing. These two hours I am dedicating to interviewing with you and telling you about my child is like two hours that is being taken away from the 700 other things I also need to do. If we expect caregivers to respect our time, we need to respect their time as well. And so if you're gonna ask a question, it better be meaningful and lead to something and you better do something with it, or don't bother asking. So I've tried to incorporate a lot of those questions with not just the kind of surface level analysis, but if you're gonna talk about whether or not a kiddo can go to the doctor or to the dentist, then if the parents say no, [00:14:00] then what's your plan?

Are you gonna start working on this in your treatment plan? And I really hope that you are. And if you don't know how to do that, then the interview forum is going to give you those resources at the end. Because anyone can identify a problem. And that's what's really important to me with the decision models.

It may showcase an issue, it's going to find you a problem that needs a solution. But if it doesn't give you a solution to that problem, you're just gonna be sitting there twitting your thumbs of like, that's great that's an issue where parents need help with that. I don't know what to do about it.

So, I'm stuck. The whole purpose behind the decision model is to then guide that user to here's a job aid, here's a resource, here's an article. Here are some tools to help guide you through if you wanna work on desensitizing kids to dental procedures, here's three articles.

Here's how they did it, here's the summary of the article to see if that's something you can bite off. You will get smarter by using it, but I do recommend that you do use it for every single caregiver interview 'cause you're gonna forget otherwise. If you're not following the guided flow of questions, you're gonna forget about [00:15:00] asking about community access and, oh wait, I forgot to ask about haircuts. Or if I forgot to ask if they know how to dial 9 1 1. Because I just forgot that was a question under safety.

Different models work differently in terms of how often you access, and for that one, I'd say you should use it for every intake, if that makes sense.

Allyson Wharam: Absolutely. And that makes total sense 'cause even if you're extremely experienced when you're in conversation, it can be very difficult to keep track of what you've asked and what you still need to ask. It just can be a way to take data during that assessment as well. And then, I think you brought up an interesting point about the intervention piece versus problem identification.

I would actually argue that the problem identification is harder than... Maybe not as hard for an experienced clinician, but for a new clinician, I can't tell you how many times we've been working on intake interviews and supervision, for example, and they're looking at me like, okay, so what, what do I do with this?

Which is that cyclical problem of knowing the intent of what you're doing, which is what you're saying. They have really limited time. They have, a million other things on [00:16:00] their plate and on their mind. And so if you're going to take that, you need to be really intentional about what that's leading to, but sometimes I think we go in and based on training, maybe you've been taught a very rigid way of thinking about goals and thinking what we're doing, or you are resulting to cookie cutter programs and things like that. And so you might not even really be thinking about the problems as you're talking through it.

Like one thing that I see a lot is when students not knowing when to dig deeper. Like they'll get a kernel of like, great information. And I'm like, okay, yeah. Ask a follow up question. Tell me more. Even just something generic. Tell me more about that. And they're like, okay, next question.

Time to move on. And I think that problem identification actually is a huge skill that can be overlooked in the context of all this. And so I love that it, helps address both sides. So will it guide you through, or maybe more, even more generally, how do you think about when to pause and dig in [00:17:00] and get more information?

Because you do have a very limited window of time when you're interviewing. And if any of us have spent time with a caregiver, it's really easy to go down these rabbit holes and say, oh wait, we just spent 30 minutes talking about this sort of irrelevant thing. And so you can go too far. So how do you balance that in terms of interview skills?

Kristen Byra: It's really funny that you mentioned that they, circle. Yes. And then just next question without thinking about wait, that was a really key critical that you just asked about.

Allyson Wharam: Really important.

Kristen Byra: Right. So it's funny 'cause there are some examples of that in the form.

So one of the questions is, is there any issues with sleep? And we ask some examples, right? Is there nighttime awakening? Did we having night terrors and things like that. And so they say yes. Then there's a whole additional script of what about it is the problem, right? So is it that we go to bed at a reasonable hour, but then we're up from midnight till 4:00 AM.

Every night. Is it that we are waking up 17 times at the night? Are we asking for, a cup of water and then I need three additional stories and my favorite [00:18:00] book and my blanket, we have all these requests because it's gonna ask you those kind of questions. It's not just sleep as a problem.

What about sleep? And I've, done so many interviews with clinicians where I'm reviewing a treatment plan and I'm like, Hey, I see that sleep is an issue. What are we doing about it? They're like I don't know, or, I don't do that. Now, if the kiddo is four years old and they are snoring like a truck driver, no, you're not gonna do that.

That's something you need to talk to parents of like, Hey, just so you know, you mentioned really loud snoring. Have you talked to your pediatrician about this? Because four year olds should not sound like a truck driver. They probably. Needs some ENT to look at adenoids or tonsils or some kind of obstructive sleep apnea.

No, you as a behavior analyst are not gonna treat that. But you can still tell parents that like, this is not typical and you should go and ask them questions about it. But if the kid is asking for 17 drinks and four books and the lights turned on and just away and Oh mom, also this, I need to tell you about the story I had, I, you know, what I ate for breakfast. Then you can deal with that and you can go read the article that's attached about the bedtime pests, right? For [00:19:00] kids who can understand those rules of how to use the golden ticket to get outta bed. And once you're out, you don't get those requests met anymore. That you can do as a BCBA.

And I think that's important for BPAs to realize. Parents don't know usually, especially if it's someone just coming into service, they just got their diagnosed two or three months ago. They've never been in ABA services or they don't even know what kind of problems a BCA can handle. It's just, I get a note from my pediatrician that says, come and get ABA therapy.

I'm here, like, what do we do? But I think as a lot of times as BCBAs, we will ask, what can I do to help you, I don't know, make stuff less stressful and I don't know anything, whatever you do. Which is also how the interview was guided to, to make sure we are hating on critical roles where, hey, are you able to go out to dinner?

Can you go to the grocery store or department store without like major meltdowns or without fear of elopement? How about driving to the store? Do you have a kiddo who is unbuckling their seatbelt, like mid car ride on the highway? Because if you're mom or a [00:20:00] dad with an unrestrained kiddo in the back, chances are you are going to zero places, right?

So are we asking about those kinds of things? Because those are things that BCBA's can be supportive in, but not if we don't ask that that's an issue. And I don't think parents would think oh, hey. Yeah, by the way. In the backseat, we are constantly unbuckling ourselves.

And so I just don't, like one of, one of us stays home, the other one goes to the store. I only can shop on Saturday when we both have off from work. If I don't think to ask, then parent doesn't know that I can't help with those kinds of questions. As you go through it, it also ask, is it a problem and do parents wanna focus on that because they should also be the ones to decide.

I remember I took over, this is a long time ago, I remember taking over and I was going through an old treatment plan from another agency. And I saw toilet training was a caregiver goal. The kiddo was four. Then surface level, four years old, that's an appropriate time.

And I saw that it was going awful, just terrible progress. Things were not going well. So I asked Hey, I see things aren't going very well. Can I ask why we're focusing on toilet [00:21:00] training? Are we concerned about daycare access? Because at a certain age some kids are not accepted in daycare.

If they're not fully potty trained, she's oh, no. I don't, I didn't wanna work on this. The BCBA told me I had to. I didn't wanna say no 'cause I thought we'd go back on the wait list. Mom got basically bullied into chaplain this because the BCBA on the case thought that he's four, so he should be toilet trained.

So guess what, mom, you're doing this. And it just broke my heart. 'cause that is not how services go. It was not a requirement for him to be toilet trained for their clinic. Of course. The BCBA thought this should be a priority. And so when we ask those questions about community access and things like that, we ask do you actually wanna focus on this?

Because if there's 15 fires, we can't put them all out simultaneously. We need to prioritize. We'll come to those eventually. So like, if going to the barbershop is a goal of yours and for now you're maybe cutting their hair in their sleep. I had a client who did that.

But we had 10 other things that were way more important to her. And so eventually we got to haircuts. But being able to go to the [00:22:00] grocery store was way more important to her so we got grocery shopping sorted first.

So I think it's important we asked the right questions, but we also listened to parents in terms of what's important to them. Because if they're not, if it's not important, they're not gonna do it. And I don't blame them. I don't blame them for that.

Allyson Wharam: Yeah, we're missing the whole social validity piece and the different layers of that and buy-in. I see all the time of people frustrated because parents aren't adhering to XYZ intervention or they're canceling sessions and things like that. And I wonder how often we're taking a step back and asking those questions of are we providing them something that's meaningful?

Sometimes there's other barriers, but at the core are we providing something valuable to them that is aligned with what they want and what they need. And yeah. I think I wanna hit on a couple of other pieces of prioritizing behaviors. I know that's after the assessment process, but so say there are 15 different behaviors and parents have said all 15 of these are important.

How do you think about that within the [00:23:00] context of a decision model, but also just in general? as just a decision, how do you think about that and how to prioritize those behaviors based on the assessment?

Kristen Byra: So in the model, there's a job for prioritization. So there's two different, there's

Allyson Wharam: Is it that lovely matrix from Cooper, or is it something else?

Kristen Byra: It's similar to that one. So there's one for challenging behavior that probably looks very similar to the one for Cooper on... I think it's from a, another like PBS workbook. If it's to deal with safety, right?

If like safety from either, safety of others or safety of self, that usually starts looking at priorities and things like that. What's the magnitude of the behavior and stuff like that. Just start prioritizing. But in terms of caregiver goals to making sure we're really, you mentioned that social validity piece. There's seven kind of areas that we want to make sure we're hitting like at least one of them.

And so look at that cost benefit ratio. By engaging in this, even if it's hard do I get good bang for my buck because if I don't, I'm not going to do it. Is this setting me up for negative interactions with my child? If this is something that I [00:24:00] know is gonna lead to a two hour meltdown, guess what?

Nope. Even if I'm told it's gonna get worse before it gets better, you're expecting me to make it all worse before it gets better by myself. Absolutely not. What are those kind of components? And so when we're prioritizing those goals, making sure that it's really, you're able to hit at least one of those seven kind of areas to make sure that it's an alignment and it's gonna lead, because otherwise you're not gonna, there's gonna be really poor adherence because we are not hitting those kind of metrics.

If they really say that all of them are valuable to them, then I would probably lead back to, yeah, that matrix of, what's the overall impact in prioritizing that way? And yeah, reminding parents. We can't do all of them at the same time. It's just too much.

But knowing that I hear you, I know this is important, so let's have a plan, right? So we're gonna start here. Once this is done, then we move on to the next thing and the next thing. Not oh, I can only help. So just pick the three that you ever wanna get us. Get sorted, let's go there. We will get to everything.

We'll just get to it at a certain time. Which we need to make [00:25:00] sure, and I don't mean to side rail this too much, but making sure that when we are addressing progress, that we are expecting rapid progress. Things should not take months and months. Or authorization and another authorization before we start seeing progress.

And those, some of the other tools that I've built not part of the interview for caregivers, but some of the other outcomes tools really help clinicians make sure that we are making progress that not only that's meaningful, but in, a response intervention that can hopefully prove back to stakeholders that yes, ABA therapy does indeed work.

Here's why we should keep doing it. This is the progress I've made and this is how much I've made and this is how I know. It's acceptable.

Allyson Wharam: That relates, I think that piece of the progress relates really intimately to even the prioritization of goals and balancing what the caregiver is looking for in terms of outcomes as well as our clinical judgment. Because I think all of us who have been doing this for a little while know that there's sometimes a disconnect between what [00:26:00] the goal that is stated is, and the current level of performance and what is feasible.

And so what I sometimes see being - it's still an outcome we're working towards, but it's not, that is not your goal yet. That's the outcome, or that's a later goal, but that is not what is going on the treatment plan just yet in terms of this, authorization. And I had a client long ago who, and I give this as an example for component composite analysis, who could barely pick anything up, had no, like really pinch, grasp, couldn't turn like.

Needed to work on all of those different fine motor skills. Didn't follow really any sort of routines, and yet we have this independent toothbrushing goal for him when he didn't have any of these component skills. And so part of that too is then saying, okay, here's the problem, but let's break it down.

We're prioritizing and then let's break it down into what is relevant right now. And then we need to be able to communicate that to caregivers of, this is still relevant, this is still important, this is still something we're working towards. Here's the first step we're taking to that. There's a lot of [00:27:00] reasons for not making progress, but I do think that is one dimension of it. We are not actually breaking down those based on the information we have from the assessment.

We're not breaking it down discretely enough to then inform the goals of where they are right now. In respect to where we're going.

Kristen Byra: I think another issue is we may see the terminal goal and in our minds have some ideas about how we're breaking it down and some kind of task analysis, and then that's not shared with the RBT or the bts that are then implementing those goals and we just say, oh, teach the kid to brush his teeth. Cool. How are we doing that? I've asked BCBA's point blank, "Hey where's the written protocol here?" And I get, oh, we want LVTs to have autonomy. Cool, but

Allyson Wharam: So they have the training to have the autonomy.

Kristen Byra: So when you look at a treatment plan that you're signing to submit to a funder, the qualified health professional, that's the BCBA, right?

They're the one who are ultimately responsible for this plan. These goals being, taught to the client. RBT can't practice by [00:28:00] themselves, right? Like you have to be supervised by someone else. They can't bill on their own, they have to be billing under a QHP qualified health provider. So I, I argue that we are giving RBT's autonomy of how we're teaching the goal. Their job is to follow the instructions and the teaching that we're hopefully doing through behavior skills training to go through, and this is how we're gonna work on it. Here's prompting strategies. Here is the SD's that we're operating under. Here's our reinforcement schedule, but we can't do BST.

The first step is like reviewing the written protocol. BST is pretty gold standard in terms of training in our field. How are we gonna be able to do that if we're not having those written protocols that fall back on the first presentation and then, oh, you showed me this on Friday for the first time and it was a long weekend.

Now it's Tuesday. Oh what did Kristen tell me to do again? Oh wait, I remember. I can go back and read it and then go implement it. There's a lot of models available. One of [00:29:00] them also for free is the quality assessment. And so anyone can go in there and evaluate their companies or their agencies, where they fall in the area of quality.

And there's five sections. It's 29 questions of either yes, no. Yes, we do this, or no we don't. If you don't, then there are suggestions on how to bridge that gap. Even if you do, there are still suggestions of great, I'm glad you do that. Have you also thought about X or you thought about Y to maybe elevate that.

And one of those is under, the protocols. Do RBT's know? Is there written protocols for all the skill acquisition goals that you are trying to teach this kiddo? Are we using BST for all the RBT's that are working with this client? So if you guys wanna know how you stack up in terms of quality, then go over and check that out.

Allyson Wharam: What we're talking about in terms of assessment is just one piece of that. You have to have a solid foundation before you get to these other things. But yeah, it's just, it's funny you went down this path because that was the exact gap at the [00:30:00] agency that I am talking about as well.

Like part of it was the mismatch of the school. That's not even the biggest kind of mismatch. Unfortunately. But I remember I had worked at an ABA clinic before. And that had obviously when you're in a clinic setting, you have a lot more training. You have a lot more oversight. Not always, I shouldn't make a blanket statement like that, but by virtue of the setting, you were around other people as a module and you have usually more access to behavior analyst.

And then I moved to this in-home setting. And I was really well trained by that point, but they would hand us the ISP and that would be it. Like the goals, there was no teaching protocols. So even for this task analysis, luckily I knew how to do it. I think by that point was even in grad school, and so I could figure all of that out on my own, but I shouldn't have had to.

And I was one of 15 at the location who were even in their program. And so when I brought that up to our supervisors to say, "Hey, we need, like actual teaching protocols," it was always framed as, oh, like you [00:31:00] need this. You just want the answers. You want these things. Not saying that I had perfect clinical, but I had more training and experience than most people to go in there and wing it.

And so I was trying to bring up this kind of systems issue, and it was always framed as oh but you're just wanting more information, so let me give it to you. Whereas I'm trying to highlight the systems issue. So I think that it's great that you have tools for all of these different areas and components, and that the quality assessment can be a good starting point to pinpoint some of the domains where you might be in strength or might need more development within your agency.

There's something that you said in relation to assessment that I wanna go back to in terms of your example with the parent or the caregiver who felt like they had to answer a certain way or that even after the intake assessment, whether they felt comfortable sharing that they didn't wanna work on it, or if it was later I, I don't know, but it leads me to, to wonder about a couple of things.

The first one is: [00:32:00] How do you think about rapport building in the context of assessment and then outside of the assessment to make sure that parent is comfortable sharing those things. Then specifically in the assessment process, what are some specific behaviors or strategies that you can use to help solicit more truthful responses from the person you're interviewing?

Kristen Byra: Yeah, I think having duplicated responses, not duplicated, I want them to do the same work, but trying to get some continuity across types of questions that, may be covering similar areas and making sure you have correspondence between those two is important.

The family quality of life scale, I'm not sure if you're familiar with it, but it's a 25 question Likert scale, so it's not, something really difficult and laborious for parents to fill out. It's really just answer the bubble, like multiple choice. They're very dissatisfied or very satisfied or neutral, a scale of one to five on certain items.

And there, there should be some overlap between some of those questions and some [00:33:00] of your undertake. If you start seeing disconnects between those two then that's an area to follow up on. If family quality of life, they said things are really challenging. I don't feel like my kid has enough friends and social supports and things like that.

And you start asking questions in the interview of, Hey, what are some hopes and dreams you have for your child in terms of skills they wanna build? And they don't mention that. There's a little bit of disconnect there. So going back and, hey, I noticed on this form right when we went through it, you said that this was an issue, but I'm not seeing it now.

So is it an issue and it's just maybe something back burner and that's okay. Or is it, we forgot about this, or, I didn't think we knew that we could work on this here. So finding those corresponding bits to make sure you have that test, retest kind of thing going on.

In the intake interview, there are definitely some disclaimers and like notes as you, the interviewer doing. It'll warn you like, Hey, you're about to approach a really sensitive topic here. Make sure that we are handling that with care, making sure that we are acting under a cultural competence.

I will say that there may be times that [00:34:00] you are not the right person to interview this family. And that you should have a different colleague interview them. 'Cause either they have experience in that area and, because of the client of some of their other intake, like that initial kind of screener stuff that's more admin like. Getting some details from that, that maybe you are not the right person to do that.

Sometimes it's best to say tag someone else in, I'm not the right person to do this. We all need practice or we're not gonna get better. But I think you practice those in situations where you're better suited as opposed to this is gonna be a really big reach for me. I've never worked with kids who have a trauma history.

This parent has been through like five different agencies and I just graduated yesterday. Maybe you are not the best person to sit there and do that interview right now. And I do wish there was a little bit more between the admin interview and us actually accepting kids into care. In full transparency, the interview that I created, I would love that to be part of the SOP.

Between the administrative intake where they're doing like the verification of benefits and they're, [00:35:00] checking their schedules align and as actually accepting the kid into assessment. I'd love for my interview to fall there, but I know most folks will not want it there. They will want it to be part of the assessment so they can bill for it, which I understand.

I understand it's business, no margin, no mission. If you answer it in a certain way, there's gonna be some questions. Do you have the right skillset or can you get immediate mentorship in this area to be able to be confident to service this client?

Are you sure your clinic can handle someone with this level of, severe challenging behavior? Because if not, you are doing no one favors by accepting them into care. And I've seen that happen a lot actually, where either we haven't done a robust enough kind of screening of interview, either at intake or at the indirect assessment part of before we've done that, authorization request or we just decided I'm sure it will be fine.

And we take kiddos and then we're doing 50% supervision as opposed to, 15 to 20. We are having two-on-one, staffing requirements. We are [00:36:00] having, massive concerns about safety of other kids in a clinic. We are having massive safety concerns, having a BT go to a home without supports.

And then we wind up discharging. Because we're like, hey sorry, we gave it a month or six weeks or something and we just can't, or even sooner than that, if it's really, you've really done a terrible job at discerning whether or not whoever is assigned to this.

And then we have BCBAs quit and we have our BT's quit, right? Because they're, Hey, go work with so and so today. The kid who's challenging behaviors, super high magnitude, and you're probably gonna get punched in the face. Oh, here's a Kevlar sleeve. Hope it doesn't, scratch it too bad. And then we wonder why people quit.

That is just super irresponsible of all parties involved to go send an RBT or BT into that scenario without proper supports and management. We should have done something, to be kind in the beginning to say, Hey, I'm really sorry, but given the magnitude of behavior or because of the complex medical needs or whatever it is, we are not the best.

We are not the best fit, but, let me help you. Here's this [00:37:00] referral. With ROI, I can even call this place. I think when we also turn away kids, we just here's a list and then we dump them on their way. It takes five minutes to get an ROI signed to be able to say, Hey, let me go call this place.

I have a colleague that works over here. Because you have to know that another clinician calling another clinical office saying, Hey Allie, do you know anyone? Is there anyone over there at, clinic X, Y, Z that has room in their caseload? I know you guys will take challenging behavior or kiddos who are a little bit older, or a kid who has a feeding issue because I just got someone, an intake and we can't handle them.

Do you have space? Because you have to know that is so much easier than a parent cold calling and starting all over to get them through that process. But I don't see a lot of that happening. I just see a, here's a word document with some phone numbers. Hope that goes well for you.

So I think we need to be better about making those determinations of who's a good fit for our practice. And then if we determine that they're not a good [00:38:00] fit, that we can be way more supportive than we are about helping them find appropriate care. That's not just an email with a list of call these other people.

I also have Google. If I'm a parent, like I can also Google like you're just giving me a list. Who else is gonna take me? 'cause then they call the first five and they also find out that they won't take a kid who's 12 either. So why did you even, refer me to those five clinics that won't take a 12-year-old.

So I think we owe parents a bit more.

Allyson Wharam: Yeah, and even within that's a pretty, extreme's not the right word, but like maybe a very obvious problem of when it would be outta scope or just not the right fit for the resources of the organization, depending on your service model and things like that. as you were talking even about sleep and if you maybe haven't dealt with that issue, like it can be even more nuanced than that of overall this profile fits what I am able to do and what I'm experienced in as a clinician, but their number one goal is sleep and I actually have no training and experience with that.

[00:39:00] And how do you handle that? How does your organization handle that in terms of, I guess there are resources and things like that, but depending on the degree of the issue there does that need to be another colleague? Can you get mentorship? Can you get support? Things like that. And so I think thinking about it in that really nuanced way too, like you said, sometimes we treat this interview process you're, you're kind of already in, you're the clinician working with this family or you know, whatever.

And at that point it can be more difficult, I think, to make some of those decisions. I was wondering too early on, as you were talking about just not even asking things if sometimes we subconsciously do it even a, I'm not gonna ask about sleep because that feels outside of my scope, so I'm not even gonna ask about it, even though it is within my scope to assess setting events, even if you're not directly addressing that thing, you still need to know about it.

But maybe I don't even ask because that's just something that I either don't have training in or, what have you. And so I think a decision model or something [00:40:00] like this, or any standard interview form can help to guide. It's not gonna give you that decision point of when to dig deeper that we were talking about.

That's a huge problem. But even as an organization, just to have something standard to really guide this process, I think is essential.

Kristen Byra: Yeah, I know there's a lot of clinics too now where it's becoming a bit more popular to have just like an intake coordinator, like there is one BCA that just does intakes or assessments and things like that. And so if I'm not able to talk to mom and dad myself I wanna make sure you ask all the things that I care about as a clinician, because how can I start building things if I don't get all that detailed information. And yes, maybe I asked about sleep and I determined it wasn't like something I wanted to dig deeper on as the intake person. And then you're gonna pass that baton to someone else and they're like, whoa, wait, what? What was it though? And if the intake person, to your point, maybe they're not comfortable with it, so maybe they didn't wanna dig deeper because they think it's maybe something BCBAs don't, shouldn't or couldn't handle.

And so then those questions don't get [00:41:00] asked. I will say too, being efficient with their time as BCBAs is also really important, right? Like we have limited time to do everything. Another goal behind the intake is that on the backend, everything that you're entering into the form. So all the notes that you're taking, all that gets transferred to a Word document with the idea that everything that you entered can then be copy and pasted you into your treatment plan so that you're not going through notes and notes. I've talked to, colleagues and friends of mine and it's like flipping through, either if we had the notebook out, I'm old, I like writing stuff down still, as opposed to typing everything.

But as you're going through your notes or scrolling through things like, oh wait, I swear I asked about that. Like, where is it? The plan is that everything is organized in a way that it's a real quick reference and copy and paste so that you're not spending time going through and trying to organize notes and make sure, oh, I forgot to, talk about their weekly routine or whatever it is.

Which is something that insurance companies wanna know, but maybe you didn't think to ask about. So having it standardized and then just copy and paste will hopefully make things easier for [00:42:00] folks.

Allyson Wharam: What are some of those larger domains that you think are important to be included in any standard assessment? I know we've already talked about some general examples, but what's the framework you use for that?

Kristen Byra: So there's a lot. There's a lot. And I think it's, there's some things that folks don't realize how big of an impact. So there's a, the longest part of the form probably is surrounding medical medical conditions and medications, allergies and things like that. I don't think folks understand how many kids on the spectrum have a comorbid condition.

So they either have another psychological diagnoses, so they're, we're having ADHD, we're having OCD, anxiety, depression, bipolar, any of those kind of things, especially as kids get older when they're itty bitties, when they're three, it's sometimes harder to get those diagnoses sussed out.

But as they get older, there's usually a little bit easier to see some of those patterns of behavior to get those diagnostics completed. But they usually also have a medical comorbidity, right? And we have kids who have GI issues. We have kids who have seizures and all sorts of kind of autoimmune [00:43:00] disorders.

And then therefore they're also usually on medication and whether or not they take medication and when they take it, are they changing dosages? Mom and dad are having an issue with him taking it all the time. Like we grind it up in the pudding, but then sometimes he spits it out and we don't really know how much he got that day.

Those things are really important from a behavioral perspective because if we start a new medication and no one tells us. All of a sudden we have some really weird behavior graphs going on up and down variability. Like someone's having a coronary heart, like massive heart attack, that's a problem.

And then if you go back and find out like, oh, it's because we switched from, from medication X to medication Y, or we increase the dose, or we added in a second, medication. 'cause a neurologist thought it wasn't, you know, the first one wasn't helping enough. That's problematic.

I talked about this in my webinar this morning, that medication side effects can function an establishing operation. And so we either have. Medications with side effects that increase our appetite. So like we are now craving food all of the time. And if you deny access to that, you may see some [00:44:00] challenging behavior.

Or you have a kid who won't sit at mealtime 'cause they're not hungry, they're on some kind of medication that's now an appetite suppressant. And how dare you make me sit down and tell me to eat my sandwich and my banana, like I'm not hungry. Those are problematic. If we don't get a good medical background, I know I often see like how many, like when was the kid born?

Was it 39 weeks versus 40 weeks gestation? Yes. I love that. That is something insurance companies desperately need to know. Me personally, that doesn't change my plan of care. The one week, you know that 39 weeks is not premature. If it was 29 weeks, right? I might be looking a little bit more closely at that.

But those other medical questions really should be impacting and guiding your care. And so there, that's a pretty big section when we start talking about. I'm talking about meds, medical other medical issues that may impact even their access to therapy if they are recently diagnosed with seizures.

Unfortunately, sometimes the first medication doesn't work or doesn't work well, and so we're still having three or four seizure events per week, [00:45:00] depending on the type of seizure. That could be like a three or four hour recovery. So your kids, only getting services for a couple hours a day and when they're supposed to be getting, four or five, all those things are gonna impact how you plan for goals, how you schedule your staff.

You need to know that going into this, not two weeks after they started. Oh, how come this kid's missing sessions left and right. Oh, by the way, we don't want any, oh, by the ways.

Allyson Wharam: Yeah. Yes. Yeah I think medication you mentioned like trauma history that can be really sensitive. And so just to drive home that point again of making those caregivers feel safe to talk about those, because some of these are really sensitive topics and so you might start with things that are not so... like you're gonna start with some behavioral momentum, start with the easy things get that report going.

But I think also making it really clear why we're asking these things. We're not asking about trauma history because we're gonna go and report you to CPS. But as a parent who maybe has tried to navigate all these systems for like, that could be [00:46:00] a really valid fear because of the complexities of navigating that system.

 There are things that I think could make it really difficult for parents to be truthful on some of those domains. Even medication that might seem really simple to ask about that. But I've encountered situations, especially working in the schools where maybe parents don't actually share what that person is taking. Or another common problem I see is they miss doses frequently, but they don't report that because they're worried about people then going and reporting them. Or, just looking like a bad parent. But then you're left guessing as the behavior's did he get his medicine today?

Like something is really off today. What is that thing? And so I think, again, outside of that assessment process, as much as you can, building that trust and rapport and almost treating it as, the functions are multifacet ed, but it is also a rapport building process for you to show genuine care for you to ask in an empathetic way and actually care about the answers. And for you to frame [00:47:00] that for them and explain to them, this is why I need to know this. This helps me to make sure that I am being sensitive to the experiences that they had. So I'm gonna ask you some of these questions.

They might be uncomfortable. We can stop at any time. Feel free to tell me that you don't want to share something, but I want you to know why this is helpful for me to know and just being really transparent about, all of that. And just the assessment process in general.

One thing that I work with trainees is just like even asking permission, just holistically, Hey, this assessment should take around an hour. I'm gonna be asking you questions about X, Y, and Z. This is going to help me inform my treatment plan. There's no right or wrong answers. Please answer as honestly as you can.

Is, how does that sound? What questions do you have? Asking for permission even before you begin the assessment. There's so many little signals and things that you can do throughout the process to just help get accurate data on those different domains because they are important and they are relevant to [00:48:00] services.

Kristen Byra: absolutely. And I, I think too, like it's not just, like I said, there's probably a lot of fear from the parent especially when we're looking at a trauma. Sometimes they've been traumatized at school, right? So if you have a kid who, especially if they're a little bit older, if they've been expelled maybe they have a trauma history from school because they were secluded and things like that.

It's not necessarily on the parents, but I need to know that because we wanna make sure if we're in an environment, like it may mirror even though we're not using seclusion, if it might mirror that maybe a trigger for anything like that. We wanna plan for it. I remember I had a kiddo who I took over care for and we wanted to work on communication and Manning with, yes or no. Hey, do you want this toy? Or Hey, do you wanna go to the park? Do you want this? And manning with yes and no, and we had to teach head shakes for no because he was told in prior services when he made a mistake, Hey what color is this?

And if he said red and it was blue, they gave a very sharp, no. That was a punisher. You couldn't even vocally say no as a model for him. To say yes or no, do you want this? Because [00:49:00] mom said, you can't say no to him, or he will immediately break down in tears.

And so that was just really important for me to know as we did programming. We did vocal models for yes, that went really well. But for vocal models for, no, do you want this, we only did a head shake. And nothing else because we knew that would've triggered really real, extreme duress for this particular kiddo.

So, all of that kind of information is helpful for us as we planned for treatment. But had I not asked, have you had therapy before? Why did it end? And how did it go? Because had mom not shared that with me, why wouldn't I model no as an appropriate response to, something that's not very exciting. This toy that doesn't light up anymore or is not in your preferred list of items. Of course we'd say no to that. Why wouldn't I? So had we not asked that, I would've, unintentionally gotten this kid really upset.

Allyson Wharam: The last thing I wanna ask you about is balancing flexibility and standardization, because what you're talking about are great examples of that. With these kind of [00:50:00] general questions, but again, knowing when to dig deeper. One thing I wanna highlight really quickly as well about the questions you were just asking, which is something that I think is also really hard when you're just learning to conduct assessments, is asking open-ended questions whenever possible.

Not just did you have a good experience with therapy in the past, but what did that look like? What was your experience like asking them in an a way that really encourages a more thorough response and indicates that you wanna know more about it and then not being afraid to wait within that.

But, back to what I was asking, is that balance again between flexibility and standardization and how a decision model, or even just an interview form, how do we balance that in relation to the person in front of us? But then as a business, how do you or just a, even a wider system, how can we ensure high quality through some standardization of that process that still allows for [00:51:00] individualization.

Kristen Byra: I get that question, or I guess I get that feedback a lot and I get that not just for me personally, but I see it when there's any kind of, like tech tool or other tools that come out of, we still wanna operate as independent BCBAs. I'm like, that's fine. No one's saying that you can't ask additional questions, right?

It's not like you end the interview, you end the form that's been created, the guided interview, and they're like, no more questions. You're done. But no, something comes up or you said, oh I always ask about this. It's not on the form. No one's preventing you from asking additional questions.

But the whole purpose of the beta is to make sure that we are getting feedback. And so if there's a question on there that feels redundant or, Hey, I'm really struggling to find out why asking this would lead to better treatment plans. That's why we're working on that, right? So if we do get that feedback, that's something to remove, you also can skip a question, right? This is also going to depend on where you're working and the SOPs that you're operating under. But if it really is something that you feel like if I ask this parent, they're gonna get upset with me, or maybe I need to ask this at a second interview, that's [00:52:00] okay.

It's not like it's a robot voice and once you push start, it like automatically makes you do anything. It is supporting your clinical judgment. It is not supplanting it. So it is not just taking over for you, it is giving you suggestions of, should you ask this, you're gonna get a more robust kind of clinical profile of your family and of your client.

And I think that will be helpful for you. I can't force you to do anything right. And nor should I. I am just giving you what I think based on my years of clinical experience based on the literature that's incorporated into it. And then now based obviously on beta testing with fellow clinicians that are also in your field.

This is the kind of a point we've come to, to say, Hey, if you ask these kind of questions, you're gonna get good insights into your family. But there's nothing that's prohibiting you from asking additional questions or forcing you to ask the ones that are listed, there is a spot in the interview where it does talk about, basically adverse experiences.

So, is there a history of punishment mandating reporting trauma, things like that. If you say yes, if [00:53:00] any of those are checked as a yes, then it will suggest that you have parents fill out the adverse childhood experience skill. No one's forcing you to do that. I think it would be helpful. I think if you are gonna be working with this family, you better have someone who really understands trauma-informed care.

And if not, this would be your chance to refer out. But. No one is forcing you to present those questions to the family or download and print that and hand that to them and slide it across the table. So I think the nicety with the model, there's no hard stop that if you don't answer this question, you can't pass go. Nope. You can just choose to skip and I will go on to the next one. There's not a stop point or a "you must do" with the models.

Allyson Wharam: I think that's a great way of thinking about it. It's a tool that you can use and. Circling back to the very beginning of what we were talking about, how you use it might depend on where you are in your career. Early on you might be using it as more of a recipe where you don't quite know what questions to ask or where to dig deeper.[00:54:00] 

And then over time you might be able to supplant more and more of that with your clinical judgment. So in that way that you're also learning. But at the same time, it is still, I think from a systems level perspective as well, just to emphasize that you also then end up with the documentation at the end.

All of these things, no matter what your intake processes, all of those things are really essential in terms of ensuring quality of care and continuity of care within that system. So I think that makes total sense, and that's true with any assessment within ABA or otherwise. We have these tools that enable and support us.

And we are also clinicians who can use our judgment of how and when to use them to support our skills. So, Thank you. This was really helpful. I learned a lot about just what a clinical decision model is, but I also appreciated diving into just some of what that assessment process looks like.

You had mentioned you're in beta right now for this tool. [00:55:00] And they can find you @upscaleaba.com, is that right? And then your last name just to highlight is BYRA for listeners. And you're on LinkedIn. You're very active there. I love your posts. And so if listeners want to connect with you, they can do that and I'll link all of that in the show notes as well.

But is there anything else that you wanna share before we go.

Kristen Byra: I am really on a mission to improve the quality of our field from where it's at. I really want to support clinicians that didn't have the same benefits that I did. And I really want a call to action be that we need to be focused on outcomes.

Not just that we pass an insurance, mandate. Not that we are an audit, rather that we are really making meaningful progress for this particular client that you're servicing and their families. And doing that at a more rapid pace than I think we've habituated to.

We shouldn't have goals that carry across authorizations multiple years. We should be looking at rapid acquisition and if we're not seeing it, we need to do something about it.

Allyson Wharam: [00:56:00] Absolutely. Thank you so much for being here and for sharing all that knowledge with us. It was great to talk to you.

Kristen Byra: Yeah, thanks for having me.

Allyson Wharam: Thank you so much for listening to In The Field, The ABA Podcast. Don't forget to visit our website at www.sidekicklearning.net for more resources, our comprehensive fieldwork supervision curriculum, and continuing education opportunities. If you enjoyed today's episode, please consider subscribing to our podcast, and sharing it with your colleagues and friends in the ABA community. Your support helps us to reach and empower more professionals in our field. Join me next week to continue to explore innovative practices and foster quality supervision in ABA.