Episode 27 Community-Based NDBI Implementation & Inclusive Early Childhood Models

In this episode of the NDBI Navigator Narratives Podcast, host Dr. Jamie sits down with Dr. Bonnie McBride, a Professor of Developmental and Behavioral Pediatrics at the University of Oklahoma Health Campus and the Director of the Oklahoma Autism Center. The conversation covers Dr. McBride's extensive background, her perspective on Naturalistic Developmental Behavioral Interventions (NDBI), and the unique community-based service delivery models she has implemented in Oklahoma.

Transcript

SPEAKER_00 0:02

Hi everybody, welcome back to another episode of the NDBI Navigator Narratives, this conversational style podcast where we get to talk to influential researchers and community practitioners who are working so hard to disseminate and help implement NDBIs in and around the world. And I am excited to introduce you all to Dr. Bonnie McBride, who is a BCBAD level practitioner who is the professor of developmental and behavioral pediatrics at the University of Oklahoma Health Campus and the director of the Oklahoma Autism Center. And Bonnie, I wrote that all down because that is a lot of really impressive credentials. Well, of course, yes, sounds important, but it is important. Thank you for joining us today.

SPEAKER_02 0:54

Thank you for inviting me. I look forward to our conversation.

SPEAKER_00 0:57

Me too. I would love to let the listeners know a little bit more about your incredible journey and what you've been on to be an NDBI practitioner and how you ended up where you're at now in Oklahoma. Okay.

SPEAKER_02 1:09

Well, um, well, first one just to mention my one of my big affiliations is with Project Data, um, developmentally appropriate treatment for autism, which um I worked with um Dr. Eileen Schwartz, who was my mentor for many years, and um she and you know was she and I and others developed the model. So so that's uh the of obviously a huge influence. Um I think I was thinking about this question because for me, and this is going to age me, but um, you know, NDBI, I I mean, it's really I've always practiced that way because in my early training, um, I was influenced by a lot of researchers in early childhood special education field or early intervention. So these are, you know, and I would say, gosh, um a good majority of them were behavior analysts by training. So people like Phil Strang and Mark Woolery and Sam Odom and Scott McConnell, Mary McAvoy, um, Steve Warren and Ann Warren, Ann Kaiser, of course, Gail McGee. So some of them are authors of that um article that defined NDBI as kind of an official term. So for me, it was really just that was, and I think if you look at like the division for early childhood, those are recommended practices. Yep. You know, all of the all of the things we talk about when we talk about what makes um something a NDBI um intervention or approach. So it was really natural for me to kind of and I like the way they conceptualized it. Yeah. So I think that's helpful to have you know something to call it. Um and I think so, so for me it was very natural. It's not something, it's the way I've always been trained to practice, it's always how I've practiced. Um and I think Yeah, and so yes, and so I guess one of the most the best compliments I had with one of my um former mentees, but now a colleague, she we had somebody come to Oklahoma to because of course there's lots of ABA clinics set up here now, okay, um, as there are in other states, I think. Um and so we had someone come and do a talk about basically naturalistic behavior. I mean, I don't think it may have been before the term came in. Yeah, before they coined that term or around there. But anyway, to talk about those interventions. And so one of my men, she turned to me and she said, This isn't new. We've all this is how we've always done it. I'm like, well, true, but it is new to some people, um, unfortunately, yeah. So uh, you know, unfortunately or un you know, fortunately, but I think that um so that's where really uh my big influences have emerged from, and uh all of those um researchers um influenced me a great deal. And of course, Eileen Schwartz, who is my mentor, the University of Washington, which is where I did my doctoral work, um, and she was a great mentor. She introduced me to people, and she, you know, I went to conferences with her and we did r you know, we did research together. So it was I had a lot of great opportunities with her. Um, and she was always very generous that way. So I felt felt lucky um to have that um mentor or mentoring.

SPEAKER_01 4:43

Yeah.

SPEAKER_02 4:44

Uh as far as so project data, of course, it has those in those influences. And um, although I will say I think project data probably has a little bit more of more traditional instruction. So, like when I when I say that, I do you know discrete trial training.

SPEAKER_01 5:05

Okay.

SPEAKER_02 5:05

I mean, that's always kind of the what's that's what's often juxtaposed against NDBI. But you know, I've always for me, it's like, well, I I think there it's really about how we put together those different components, right? Because naturalistic strategies also are could be discrete trials because you know you gotta have a stimulus that you're gonna respond to and then you're gonna, you know, re reinforce it or whatever. So you gotta have you're gonna have all those components. Um, if you're gonna prompt, it's gotta be before or as the child responds. So there's important pieces to um to I think discrete trial as a format. Now, I think what's happened is of course it gets associated with mass trials, you know, decontextualized reinforcement, all of those things. Now, I will say sometimes I think discrete trials are necessary. Um, we build it into our program for certain, you know, there are certain skills that chill children will never initiate to learn. It's like you gotta, you gotta get them, get them into, you gotta, you know, um lead them there and um kind of set up that some of those contingencies so they learn how to respond to contingencies or to respond to re requests from adults or from the you know, their peers. So I think those are you know, it's important initiation responding is also is just as important as learning to initiate. They're both, especially when you're little. So both need to happen. So and I and I don't think there's anything, I mean, I think I would I think all of the models that use NDBI as their, I mean, I would would agree, I would assume. And if you they use both too. So not maybe not discrete trial, but they use that platform.

SPEAKER_00 6:55

Yeah.

SPEAKER_02 6:56

They use that framework and they talk about how to deliver reinforcement effectively and you know how to make sure you're not teaching kids to respond to the wrong cues, you know, because we know children with autism often aren't you know, they're not discriminating the cue they're that we're trying we want them to respond to. So we have to, you know, sometimes be really explicit about that. Um, I do think there are times when you know lots of practice on a skill is useful, you know, they learn it more quickly.

SPEAKER_01 7:30

Okay.

SPEAKER_02 7:31

Now you have the downside, right? There it you gotta you gotta generalize, you gotta work harder to generalize the skill, and you have to maybe and you want to make sure you're maintaining it over time. So so I think there, you know, there as as everyone's pointed out that talks about NDBIs, is there's you know, really um, you know, you're making a lot of decisions just like you would if you were doing discrete trials. So um, and I think that the distinction that's made about you know being more focused on child motivation, that's important. But I would hope that if you're doing discrete trials, that you're also correct um using child, you know, mote child motivation to engage that child in learning. I mean, otherwise, you know, it's not really um probably going to result in the outcome that you want, right? So um, so the other thing I'll say too is one of the experiences I've had is I think discrete child, that more traditional, I'm calling it traditional, but that um approach is not just useful for children sometimes, but it's useful for adults that are learning to do this intervention. And I think one of the things that we've all and Eileen and I have talked about this a lot over the years, is it's really, you know, the net you read the article, the NDBI article, the 2015 year, it's like, wow, this sounds great, and everything, you know, you're you're synchronizing, and but it's like, what does that look like? How do you teach someone to do that who has no experience, you know? Because if you look at, you know, the way that our service structure is set up now is you've got you know registered behavior technicians who are delivering the intervention, you know, it's more of which I think is you know, it can be an efficient way to do it, but you're having you have people coming in that have no, you know, you're they're learning from square one. Um, I think the fact that we've been our work has been a lot in education settings. So we've worked a lot in public schools, we've worked a lot with Head Start. Um, recently I've been working a lot with um child care centers because you know, so that they can keep kids on the autism spectrum in childcare. So because that's such a a big issue for families. Um so there's so if you're looking at um those contexts look different than a clinic-based intervention, obviously. So so I think um that's more my orientation, yeah, and where I've worked worked more is in those education settings.

SPEAKER_00 10:09

I would love to learn more about the child care. That's an incredible extension of a kid can get some incredible work done and support in a clinic setting, but then if that child can't go to daycare or they don't accept their accept, then that is another burden or barrier to a family, and that would be incredible. I I don't know of any providers that are going into daycares and doing anything from a systems lens. Can you talk more about that?

SPEAKER_02 10:36

Well, we're just yeah, we're just starting, but um, you know, and I think that I if I remember correctly, I think like Aubin Stomer, who I've love her work as well, and she I think she's done some work in childcare settings as well, um, too, um, with her model, which of course I'm forgetting that children, oh gosh, uh can't remember what it's called. I hate that. So I um anyway, Google she has a model, an early intervention model. Um, but I think she has done some work, and I do believe that um I've read some some work by you know using like yes, you know, early start Denver model in child care centers or child care environments. So so anyway, back to so I think it's one of the things I found is that a way to enter the world of intervention is through for adults is through learning how to do just basic instruction. Because you can give them all the theoretical background and you can go through what this means and they're and it's just like blah, blah, blah. I mean, they they're not understanding any of it yet because they're right, because they're just um you know, they're just starting to, you know, have a grasp of these concepts. And so um to be able to then take that and put it into act what it actually looks like interacting with a child is a a big leap, I think. And I think we know that when um when you look at you know, just workshops in general don't um change practice as much as we would like them to. So um so that's where I think so I think uh we found that that's an and it's a way to enter that interven that world of intervention, or how do you have an instructional interaction with a child? Um how do you, you know, make it fun? How do you set up the environment? I mean, in the child care centers we're working, it's just like things like having fun materials on the table or on the shelves, or you know, just that basic level, like how you can adjust the environment to make it more motivating. Um and I think one of the earliest childcare centers we worked with, and I guess uh a lot of times the children that are in their centers haven't been diagnosed yet. They but the the issue is more, you know, there's challenging behavior, and that's usually what exits them from programs, um, childcare programs. So so we are kind of coming in from that um that lens is you know, okay, this child's struggling with some behaviors that we don't know how to address. Um, and so we can come in and just talk about, you know, motivation. And so it's really some basic stuff. Classroom-wide. Right. Classroom-wide individual interactions, maybe how you might set up um, and again, it's really not so much around intervention, it's around being able to be successful in that environment. And of course, you know, learning is part of that, but but we're not doing um maybe structured lessons around the areas that we would work on if if they were, let's say, at Early Foundations, which is our early intervention program in Oklahoma.

SPEAKER_00 13:51

So um and before we started recording, I'm sorry. Okay before we had this recording, you had mentioned that Early Foundations, which is your early intervention site, was on campus and in the community for reasons like this.

SPEAKER_02 14:06

Yes, right, exactly, reasons like this. And and I don't know, I'm I'm actually not sure if this is true or not. But when I came, I came from Seattle to Oklahoma, and I I came here um because well, there was a position, but also my husband wanted to live here because he had some career work connections.

unknown 14:28

Okay.

SPEAKER_02 14:28

Um, so we came here for that reason, but we also came because there was a position in the Department of Pediatrics, and the the section chief or the chair of that department was really wanted somebody that had intervention background to really have some impact on uh treat interventions, treatments, you know, being able to help from that side, as opposed to, you know, they have people, they were had people who could do diagnostic evaluations, but they wanted, you know, to have people who also knew how to intervene and help kids and families. So so he brought me in for that primary reason. Um, but when I got here, there was on every corner, there are a lot of churches, as you might think.

SPEAKER_00 15:11

Yes, we are.

SPEAKER_02 15:11

Yeah. Um and they have these mothers, they call them mother's day out programs. So I don't know how common they are in other states, but they were in every they were everywhere here. And so they're not full, they're not full-time child care. It's usually like nine to two. Um, but parents can drop their kids off, they can go two days a week, three days a week, you know, it's very, you know, there's a lot of less flex, there's more flexibility, I guess. Um, but you don't have certified teachers, you don't have people that necessarily have a lot of background in young children. Um, so it's it varies a lot, I think, in terms of what the kids are you know accessing, but it's usually play, you know, they just have toys that the kids play, they have a nap, they eat snack or lunch or whatever, you know, that kind of thing. So I thought, okay, well, um, you know, we needed a space, yeah. And we also would, you know, an important component of the project data model, which is what we were implementing, was that you know, regular, consistent access to peers. Um, so that, you know, for multiple reasons generalization, socialization, all of those things. And so um the Mother's Day Out program model fit perfectly because you know, kids aren't there every day together. So it wouldn't be unusual for the children on the spectrum to only be there two days a week, because there were other kids that were also in play group two days a week. Um, so so that doesn't create a situation where you have this kid that just comes and goes. And are they really a member of the classroom? You know, probably maybe not, probably not seen as as that. But but so in this case, because we were able to structure our programs, we have Monday, Wednesdays, and Fridays, we do more um, we have more sessions where we're doing more, I'd say traditional, a combination of traditional and DBI interventions for a 20 to 30 minute time period, because you know, you got these little toddlers. And so, you know, and they get taught, and so then and then we transition to a child-centered, you know, like um introducing things like outdoor play and snack time and um, you know, free play, because that's also something they need to know how to do. And so we have so our rooms are set up a lot pretty much like a classroom. If you were to walk in, you would think this looks like a classroom. Um so then, so the Mother's Day Out, um, the kids go in on Tuesdays and Thursdays to their Mother's Day Out program. And they come in, all the kids come in together, they come in together, they're they do all the activities together, and then we do have additional trained staff that are there to support the children on this on the autism spectrum. Um I think one of the other things that I think is really unique about the way we've inter we've um implemented early foundations is that we've worked with our state early intervention system. So that's our Part C services. And here, of course, it's Sooner Start. Everything is sooner something or the Sooner State, you know. Um and so uh so we so that so Sooner Start is our state's early intervention system. So I've had a great, long, very long term, long-standing collaboration with our Sooner Start um intervention system. And so that's how kids get access to the program is through Sooner Start. We do not require, right, because that's they have to have qualified for services through their heart C. And then then there the um the clinicians who are seeing the child, they um kind of decide who they wouldn't like to refer to receive these more intensive services. And of course, you know, the parents we you know agree they have to provide their own transportation, so that can be tricky for some families. So it's not perfect, it's not a perfect setup for sure, but but I think um the good the upside of that is we do not require a diagnosis because I don't know in our state, like it can be up to a year to get a you know, get a diagnosis. And when you're talking at you know, these young ages, that's a long time, a lot of missed opportunity. So um, and so we're you know, we're not billing insurance. Um, so we are able to offer it to kids who do not have a diagnosis, they just need to screen at risk.

unknown 19:44

Okay.

SPEAKER_02 19:45

And um, and then qualify for services through Part C, which has their own requirements in terms of delays, etc.

SPEAKER_01 19:53

Yeah.

SPEAKER_02 19:53

So um, so I would so I think that's it it it to me that is a plus because it gives kids access to these services um without having to wait and to get a diagnosis and then go through that whole process.

SPEAKER_00 20:07

Yeah. And then having it in the community gives parents easier access to, like you said, mentioned it, you mentioned earlier about going to the university and parking, just access to getting places. It just puts it in the neighborhood where they might live or reside. And so access kind of go in both ways, limited uh removing the barrier to access for a diagnosis because you don't require that, and then also being in a community setting where families, if they have to travel, maybe it's not as far to the university because there is a local um Mother's Day Out program closer to them.

SPEAKER_02 20:41

Yes, exactly. And so and the kids that we um recruit, or the kids who are enrolled in the Mother's Day Out program come from that community around where we're located. So again, you know, there's always the there's always that pull to be like, okay, we're gonna open the autism. We have an autism center, although we're not really a physical building, um, because we're all we do work in the communities a lot, but um, you know, it's always, you know, that that the everybody wants you to have a place and everybody comes to this place. All the kids come. Yeah, brick and mortar building, and all the kids with autism are going to come here. Well, that just isn't I don't think it's good practice, but it's not realistic either. So what we we do have five early foundation sites that are located around the state. Um, of course, they're all clustered in the metro, in in the you know, the metro areas. Um unfortunately, there are lots of challenges for more rural um parts of the state. That's a whole other conversation. But so in these metro areas, we've got you know them in like five different counties. And um, you know, we're not serving large numbers of kids because we're, you know, we've got space, we have to, you know, we have space challenges, we've got, of course, cost and all of that. So so there are some Again, it's not a perfect system, but it's worked well um for you know a lot of the families that have come through this program over the years. So we've been here about 18 years. Okay. And so yes. Is that when you went to Oklahoma 2020? I moved, yep, 2006. Exactly. Good memory. Yep. I came here in 2006. I just 20 years celebrated my 20 years this this month or last month. I know. I don't know if that's a clapping or a clapping. But no, I, you know, it's been I've had lots of great opportunities here because, you know, there's there is something to be said for being in a place that, you know, has great, oops, sorry. Yeah. Has great needs because you have more opportunities to then create programs and and all of that, have that influence.

SPEAKER_00 22:50

Innovative with that. And I think that innovation would be welcome there as opposed to pushing up against an established system that might not be working, but that's how it's always been done. So that gives you a little bit of an edge.

SPEAKER_02 23:05

Absolutely. And I think you know, more some yeah, some more flexibility in that way. So that's you know, the downside is you know, we don't have as many colleagues that you would have if you were on the west coast or the east coast as we've talked about, um, who uh, you know, where all of the people are located that you know have all the you know the research dollars and the great um programs.

SPEAKER_00 23:28

So coastlines. Right, right. So the Midwest is great. You all listening should come here, look for jobs and move. I'm in this island all by yourself.

SPEAKER_02 23:39

And you know, you have lots of, you know, you just have to be more intentional about those collaborations and reaching out to people. So so that's um that's worked well. So I think, you know, and this was in Oklahoma, this was the framework we used for our the um clinical trials we did of Project Data, which we we had some participants that were in Oklahoma in Seattle and some that were in Oklahoma. So um looking at, you know, just looking at outcomes and we had did have a a non-data group. So we we can't say they didn't have any intervention because they were all in state services, you know, state sponsored services. Um, so yeah, so that's you know, that was the the the context that we did the work here in Oklahoma.

SPEAKER_00 24:31

Um so sorry. Oh, go ahead. Um, do you guys ever have anyone reach out for consultation? Like say there was somebody listening who said, Oh my god, that sounds amazing. I live in a place where there's not a lot of resources or it's real far to get to the center, or I would really like my child to be in the community and they wanted to replicate or extend what you have created. Is that something people ever reach out to learn how you've done that to then try to or have support from you all for how to replicate that there or different countries? I'm trying to think.

SPEAKER_02 25:04

Right. Well, you know, I have to say a lot of those requests go to the University of Washington. You know, so Eileen and she has a group of people there that have, you know, supported replicating the project data model. Um so I mean, I it's not that I'm not open to it. I just think that people, you know, I've done that locally. Like we have there's quite a few of our school districts in the area who um I will say I'm very proud of the fact that they've all um not all of them, several of the big districts have implemented an inclusive classroom model that's similar to the way Project Data is set up. So you have you know pre-K kids and then you have um up to five kids on IEPs. Now, I actually like the way the districts are implementing the model even a little bit better than data, because data was just focused on kids with autism, right? Okay. Well, certainly any child with a developmental delay or disability is going to benefit from NDBI strategies or um, you know, good practice. And so I think um so that was so they have implemented these, the kind of the structure of project. So they've got the the combined, you know, kids, so it's a smaller class.

SPEAKER_01 26:21

Okay.

SPEAKER_02 26:21

Um then typically I don't we have universal pre-K here, which is, you know, you know, one of the things, well, all maybe the one of the things we can say we're we have in Oklahoma that's you know advanced in in the area of education, but so we do have universal pre-K. So most districts, all districts have some pre-K. Okay. Um and a lot of the bigger districts are offering pre-K full day now. So the kids are there, you know, full day. And so that's a great opportunity, I think, for a lot of kids to be somewhere um, you know, learning and getting ready for, you know, going to school. So so there um so because they we have that structure already in place, we it was easy to kind of combine a autism special education or just developmental delay classroom, is what they call them here, um, with a typical pre-K classroom, and just, you know, you've got, I mean, there 10 kids is the maximum they're supposed to have in like a three-year-old program, but oftentimes, you know, goes above that sometimes, unfortunately. But but but anyway, that's the basic and role, you know, so 10 and then you've got 20 kids who are in pre-K, and then we put them together, and then we have 15 and 15. Okay. And then, you know, one's taught by um the special education teacher and one's taught by the pre-K teacher. Okay. And then you have support staff in both of those rooms. And so that's you know, that's really been, I mean, that it they've done a, you know, these districts have implemented this model. I think it's you know really great. Um and has been really they it's been real successful. Now, you know, there's again, it's not perfect, you know, there's not all kids have access to it because there's sort of a a little bit of a prerequisite, which in my mind is a little bit of the downside of NDBI, because theoretically it shouldn't matter what the child's skill level is. They should, you know, NDBIs can work with any child at any skill level. However, I think when they're being implemented in a classroom setting it, but and you have a child that has high needs and a lot need a lot of support for for learning, it's not it's hard, you know, it's hard, I think, to get that focused instruction done. Yeah. And I can relate to that because you get to the end of the day and you're like, you know, you have this whole plan. Okay, I'm gonna give like five opportunities to request, blah, blah, blah. And then all of a sudden Bobby is climbing the, you know, the the the bookshelf over here. So you gotta do it. I gotta go get Bobby. You know, there's disruptions and there's things that happen. And so, um, so it's sometimes hard. You get to the end of the day and you're like, ooh, I didn't really teach that much, or at least the things that I wanted to teach didn't get done. So that's why we decided to do that blend, you know, where we have our three days a week that are kind of more one-on-one, um, and then two days a week in the classroom.

SPEAKER_00 29:24

So yeah, and that's more spiel on that. Yes. I wrote down something you had said, instructional interaction with the child. And I love that. I feel like that's a great way for people to understand, you know, I feel like you could interpret that a couple of different ways. One of the things I always kind of hear with NDBI, oh, you're just playing. Oh my gosh, no, do you know how hard we're working to make it look so naturalistic, but present and productive at the same time? And for me, that instructional interaction with the child you mentioned, it's part of that productivity of here and we're teaching, whether it's uh uh contextualized or not, or natural or trying to find that balance of everything. I think some people kind of look sometimes of no, we have aims and goals and data. Yes, that's the best way to do it, which kind of goes back to being aligned in those community settings with the EC recommended practice that you talked about um a few minutes ago about the importance of that and how well that just kind of aligns for NDBI, especially in the school settings or community settings that you're in.

SPEAKER_02 30:28

Yeah, I mean you have a natural set structure, but again, you know, there's all the challenges we talked about. And I think, you know, I think, you know, one of the critics, not criticisms, but concerns that I've had heard from you know practitioners in more school-based settings or early intervention is you know, some of the NDBI models are they're say they say they're too complex. Like they're, you know, there we there's a you know, a book this big, and it's got, you know, caught all this text and people aren't gonna read it all. And um, you know, how do we get everybody trained? And you know, so all of the things, you know, that we know are challenges for for any new, you know, when you're learning something new as an adult. But I do think that um it there, I do think we got to figure out a way to make these interventions accessible to people that are with kids every day because we know how to do this. It's not, you know, you look at the research, and like there, yeah, there's some new studies that come out, and you know, maybe a different, you know, a little better way to teach joint attention or whatever. But you know, basically a lot of these interventions that we're using that we talk about have been studied and like we yeah, we know they work, they work really well. Um, and then how do we get those interventions in the hands of the people who are interacting with the kids? And um, so I think that's our challenge. So my interests kind of moving forward around are really around that kind of implementation science aspect of how do we get these best practices, these, you know, research supported, you know, uh uh procedures into, you know, how do we get them into the hands of or the knowledge base of, you know, whether it's teachers or clinicians. I mean, I will say, you know, there are BCBAs that don't get training in NB N DBIs in Oklahoma. I don't know about other states, but but they may not get that training. They make it, you know, much more of a traditional, um, kind of more clinic, kind of sterile environment. The child walks in and there's a table and a chair, and hopefully we're getting away from that, but I still think that's out there still.

SPEAKER_00 32:47

So I really appreciate and uh I'm super envious of your incredible mentors and people that you've had the the great privilege of learning from from that developmental background, or you can kind of circle back to again the DEC and kind of everything about entry into this kind of world and how it's just always been that way. And you know, for me that was not the experience. I didn't have that background, I didn't really get into it until I got into SEIs, and then the light bulbs just started blinking of if we are supporting young children, why do we not get trained on like that? Should be a developmentally appropriate practice. And yes, it might be outside the field, but again, it's specific to the population you're focusing, you need to know as a specialty. Um I don't think that is um really trained or coached unless you have somebody who brings that to you. I think that's a huge thing that's really work on in our field.

SPEAKER_02 33:46

Yeah, absolutely. And I, you know, it does, and it's not, you know, so so I'm really interested in like how do we how can we create um, you know, a trade, some I don't know if it's gonna be a training package. I mean, we have our own um model we use here and and also project data where it's you know, there is some trad, you know, the the kind of behavioral skills training, you know, which we know works well in in that you know behavioral environment. But also, how do you bring in the child development? How do you bring in like what do little kids like to do? You know, you kind of need to know that if you're working with that's right. Um, you gotta know how to change a diaper, you know, there's some just like practical things. So um, so I think those things, you know, those, you know, understanding like the context in which you know neurotypical toddlers are learning is really important to know that. You may not you may not be able to always use that context with all kids that need support on the autism spectrum because you know, they're not learning, they're they're having they're struggling and learning, learning in those kind of typical environments or they wouldn't have been identified, right? So, so I think that it's important, you know, that's obviously you have to, you know, adjust and meet the individual needs of the kids, but you also have to know this this other piece of it exactly. And I think you know, kids get older, and that's a whole other discussion. Like what you know, then you don't want to be developmentally appropriate because then you have people saying, Oh, he's functioning at an 18-month-old level. So, well, he's not you're not gonna do 18-month-old things with this six-year-old. Right. So, so anyway, that's a whole other podcast episode. Whole other ball of wax, you might say. So, but anyway, but that's so so I'm definitely interested in that implementation piece. And I really am working on um uh a follow-up for um some of our kids that have been in both in Seattle and Oklahoma in the project data model. And I mean long-term follow-up. So, like they're now like this cohort we had of kids that we, you know, collected data, um, they are probably in elementary school now because it was a while ago. So, but here's one of the things like one of the things we've learned from the data that they've that they've analyzed from pre-K in Oklahoma, because that they've actually used Oklahoma a lot to look at um, you know, outcomes for kids who are in pre-K versus those who aren't. But you know, you may not see, you do see some immediate effects for sure, differences. But really, what we're seeing more, they're seeing more powerful um outcomes later on down the line. So, you know, health benefits, they're more likely to um, you know, go to go to college, they're more likely. So, so you may not see like, oh, their you know, IQ score, you know, went up this much because of this intervention. It's really about like these kind of downstream benefits of being able to get these foundational skills that we're teaching young kids. Um, and so I just think you know, I think it puts them on a different trajectory, gives them opportunities and access to things that they may not have had if they hadn't learned those things.

SPEAKER_00 37:10

So that's my important discussion processing point for practitioners who are programming. Are you working on the thing at the right time in the right setting that's socially valid and meaningful for the children at whatever chronological or developmental age? And are you making it all matrix together somehow? Right, right. So what are we looking at? This is gonna help the store to this, this is gonna set them up for think about preschool kindergarten readiness, like yay if you know your ABC one two threes, but how about executive functioning, emotional regulation, tolerating being around others, playing with others, sharing like those social emotional skills that are really take or break for the behaviors, not the academic.

SPEAKER_02 37:55

Absolutely. That's the academics. They don't, I haven't. I have not in my whatever 20 or actually longer than that, many years, I want to say experience. I've never heard of a kid getting asked to leave pre-K because he doesn't know his ABCs. Right. But you definitely hear, oh, he's not potty trained, or he doesn't, he can't, you know, he has you know challenging behaviors because you don't he doesn't have a communication system, you know. That's kind of you kind of need that, you know. So so those are the things that um those missing those skills are what keeps you out keeps kids out of uh typical environments.

SPEAKER_00 38:30

And that goes back to the my experience. Yeah, the access that you're talking about.

SPEAKER_02 38:36

Getting access. And so so I'm real curious. I mean, I have a lot of anecdotal evidence, but I'd really like, you know, just you know, parents reporting back, you know, their child is now fully included in general education. Now it's not a hundred percent of the kids, I'd say about half of the kids. So it's about the same kinds of numbers that you see in other um intensive interventions. You know, you've got kids that that you know that are responding really well to the intervention and the structure and they're learning really quickly, and then you have a percentage of kids who will need probably need support, and then you have another percentage of kids who are gonna need long-term support.

SPEAKER_00 39:15

Is this not the works, this project in the work?

SPEAKER_02 39:17

Like it's gonna become a well, it is, it's in the works, but I mean, the you know, of course, part of the you know, I'm part of it is just the funding to do, to go, you know, to so I'm trying to kind of piecemeal it together because you know, I've I've um that's a call. It's it's not really, you know, people people, you know, a lot of the institutions that provide funding, they want a new intervention, they want the new thing, you know, that's what they're funding, or they want something very specific, like I'm gonna improve X, Y, and Z with this intervention. Um so looking at programs like that, we've kind of gotten away from that. And I think there's benefit to that. I think we kind of know, like, okay, you know, there's not one program. There was this study that um who was the first author on it? Uh Sally, Sally Rogers was the first author on where they did a comparison between NDBI and more traditional ABA. Um, and you know, they found really no differences. There they both work, you know. They both work, and they're gonna work differently for for different kids. And and so, you know, when you so I think there's um, you know, but but early intervention matters and getting some, you know, learning important skills matters, I think, for for that trajectory. So I'm hoping that we'll get some funding. Um, and if not, kind of piecemealing things together just to go back and you know follow up with these kids. So well, that'll be a really important space to watch for that.

SPEAKER_00 40:44

I'm gonna make sure I link everything um that we've talked about and some of the notes, like the DEC practice guidelines, I think would be great to leave um the early And that's division for early childhood.

SPEAKER_02 40:55

So just to know that's the acronym, and it's a it's a um chapter of the Council for Exceptional Children. So which is the the big organiz, you know, the big professional organization for people who work with children. That is my disabilities. Yeah.

SPEAKER_00 41:13

So yes. I feel like NDBI is going to be all over there, like, oh, you might not call it that, but that's right. No, absolutely. Right.

SPEAKER_02 41:34

That's I mean, I think a lot of the people I mentioned before have presented studies they've done over the years, and um, and you know, so yeah, but it's all you know, the basis of the of their work is I would say and you know, yeah, NDBI related interventions.

SPEAKER_00 41:53

So the values just track all the way across them. Oh my god, any recommended resources or how you stay up to date or where you find information about it?

SPEAKER_02 42:05

Yeah, well, I mean conferences I think are a great if you can if you have the ability to attend conferences, you know, uh, you know, there's obviously a financial piece to that. Um, but I, you know, conferences, um, staying connected to colleagues that are in the field. Um, and so I I have, you know, I try to be members of working groups if I have that opportunity. Um, and then, you know, it's hard to keep up on the literature, you know. I was, you know, it's like a constant um a constant struggle. But I think, yeah, I think that um, you know, you can some of that happens by just being um in contact with other other people in the field and they can, you know, make recommendations or and then I have my favorite people that I follow, you know. So so that's always good. Um oops. So did you mention books? Did you have a few books that you mentioned? Well, I my computer is going to restart. I hope it doesn't start. Okay. Well, one that I really like is um you can see I like it because I got all these. So this is classroom, classroom pivotal response um teaching, which is Avin Stomer's the first author on that. And of course, it's you know, based on um PRT principles and practices. So so I think a reason I like that, because again, you know, you read early start Denver model, similar things in there, but I think they did a really nice job of simplifying complex topics and in a way that's easily digestible, I think, to people that don't have a lot of experience in this area. Shoot. Are you there?

SPEAKER_00 43:46

Yeah, we're still here. Okay. That's okay.

SPEAKER_02 43:51

Um so anyway, that's one, of course, project data. I really um that's the kind of yeah, the Eileen Schwartz is the first author on that. Um, and there's a manual for that. Um, the leap model, which there's not as much people don't talk a lot about that anymore. But you know, when I was that was one of the first. Yeah. Yeah.

SPEAKER_00 44:11

So I'll see if I can find a website. Still strained yeah. Yeah, yeah, it's in Denver. I got to take a tour of one of the classroom sites. It was cool. And I think I got a manual, probably still have it and a binder somewhere in a drawer. Like it's hard to find something. That's another great one. Yeah. Learning and autism program, learning it.

SPEAKER_02 44:32

Yeah, of course, I can't remember what the acronym is, but yeah, we'll link it.

SPEAKER_00 44:36

But yeah, I know you're talking about that.

SPEAKER_02 44:38

That's a good one. Um, but that's a great, I mean, obviously, that's a great model. Um, you know, ESDM, um uh Amy Weatherby has done a lot of really great work. So the CERTS model, which again, you know, these people think these are when the feedback I get, and that's true about project data too, like this is overwhelming, this manual to to general practitioner, you know, like they're like, I don't even know where to start. Um, another book that I recommend a lot, it's not autism specific, but it's called Building Blocks and Susan Sandal and Eileen Schwartz are are the authors, and you know, Susan Sandal, obviously, she's you know, she was a mentor of mine too and had a lot of influence on me. So um, so but that book really gives you practical ideas like how do you set up your classroom and how do you plan to do instruction across the day. So it's it's pretty practical, it's got some nice practical um strategies in there. So those are some of the places I go for um or of the things I recommend when I'm working with new teachers or school districts or whoever.

SPEAKER_00 45:42

So oh my God, I got a cramp in my hand from all the notes I've been writing on resources and all of this amazing content you've been sharing. Oh my god. Well, thanks.

SPEAKER_02 45:51

It's fun. It's been fun to talk with you about all of these things.

SPEAKER_00 45:54

So for everyone to look at and to learn. Yes, I appreciate your time and your expertise and the depth of your knowledge in all things related to community practice, um, early inclusive settings. That's such an incredible avenue, I think, for us practitioners that are working in clinic-based models to really um broaden their horizon and think about how do we not infiltrate, but kind of integrate within community settings or what bridges can we make to help transition kiddos out into an environment that can really successfully um support them. And I think there's some really incredible, groundbreaking work as a model to say it can be done. And here's how we can kind of reverse engineer what what does a child know to be successful in this setting? And think about that when you're programming in your clinic to think about that bridge or path or journey or whatever you want to call it and back and forth. That's a really innovative um what you're gonna say.

SPEAKER_02 46:52

Well, I I mean, I think it it's you know, it's really goes back to the to the principles of baby, you know, that Don Bear and um and folks, you know, identify like you know, socially important behaviors are those behaviors that you need to use in the environments that you're in. So um so I think it's just kind of it's always good to kind of go back and look at your roots and say, am I am I practicing in this way? So that we don't forget, you know, what the intent intentions of ABA were initially.

unknown 47:24

Yeah.

SPEAKER_02 47:24

So wise sage words. It wasn't a it wasn't a individual practice, it's a science of behavior. So yeah.

SPEAKER_00 47:33

Remembering that's important. Yeah, such good words of wisdom to end on. This is an incredible. Thank you so much.

SPEAKER_02 47:40

Thank you for inviting me and appreciate it.

SPEAKER_00 47:43

That's been wonderful.