Episode 16 Inclusive Classrooms, Playful Learning, and Parent Partnership

In this episode, we’re joined by Christine Gomez, an NDBI mentor at the Southwest Autism Research & Resource Center (SARRC) in Phoenix, Arizona. Christine shares her journey into the field of autism intervention, how she discovered Naturalistic Developmental Behavioral Interventions (NDBIs), and how her work in inclusive preschool classrooms has shaped her views on child development, play, and parent collaboration. With deep experience in implementing Pivotal Response Treatment (PRT) and integrating developmental strategies like the Early Start Denver Model (ESDM), Christine offers a grounded, joyful, and developmentally affirming perspective on early learning environments.

Transcript

SPEAKER_00 0:03

Hey everybody, welcome to another month with an NDBI mentor. We have Christine joining us from Not So Hot That I Just Learned Phoenix today. Christine, will you take a few moments to introduce yourself, tell us about where you're working, the research you're doing, and then we're going to get into some really exciting questions.

SPEAKER_01 0:23

Yeah, absolutely. So I work for the Southwest Autism Research and Resource Center. We love our abbreviations and acronyms in the AVA field, also known as SARC. We are a nonprofit organization that not only focuses on delivering clinical services for individuals with autism, but also offering a lot of research opportunities and community outreach as well. Our mission is to advance research and provide a lifetime of support for individuals with autism and their families. So fun fact our youngest client is six months old. And our oldest right now is 36 years old. But we we take that lifespan very seriously. So we have a lot of really cool different programs, you know, employment-based, being able to monitor milestone development to help get that early diagnosis if it's necessary. And then our vision is to meaningfully integrate people with autism into inclusive communities. And that's where my specialty kind of falls in place is through our community school program. So I'll get into that as we move along. Yeah.

SPEAKER_00 1:48

And so this will be really exciting to talk about within the realm of NDBI. How does that kind of pull through from, like you mentioned, your littlest learners kind of moving into transitions to school-based or adolescent adult? Do some of those strategies and mission vision kind of pull through that way? Or NDBI is kind of hang out around here with the younger ones and it kind of morphs and evolves as it goes?

SPEAKER_01 2:15

Yeah, no. So actually SARC as an organization has really um uh aligned um and all of our intervention um kind of revolves around pivotal response treatment. Um so whether you're six months old or whether you're 36 years old, um you're going to get some um exposure to that. And all of your um, you know, intervention designs are going to um involve that. So um that is um just one uh of the of the ways. But I think for our youngest two, um, we've infused pivotal response treatment with the early start Denver model. Um, so we can get into that a little more as well.

SPEAKER_00 3:02

Yeah, that would be great. And what I always like to ask first is how did you get into NDBIs? What was that journey like? Or or like for me, I started in traditional ABA. I'm in a very different place now, almost 30 years later than I was when I started out. What was your journey like?

SPEAKER_01 3:20

Yeah, so um I um had just graduated um with a degree in psychology and very, very broad degree, right? You could take it so many places. Um, so I truly had no clue um what I was doing. Um, I was a little bit lost. I did a quick Google search looking for some internship opportunities, and then Sark popped up. Um, I knew I loved working with kids, but I knew nothing about autism. So, you know, I connected the dots of psychology, autism, kids sounds fun. I'll give it a try. And my first week as an intern was our annual Halloween parade where all the students dress up, walk around the clinic trick-or-treating, um, very dedicated to it every year. But again, I had no idea what I was doing. And the clinician that I was working with at the time had explained to me the importance of the activity. Um, you know, it's not just for celebrating, it's not just because Sark likes Halloween, but um, this is such an important part of life for so many families who may or may not be able to participate. And um, they were really dedicated to helping uh the families and the kids, you know, get exposure to wearing costumes and walking around and saying trick-or-treat and thank you, and you know, waiting for a turn to waiting to be handed the goodies that you get. Um, and I was immediately just sold. And I absolutely loved it. It was such a memorable week for me. Uh, just seeing the kiddos so happy and successful and the families being able to take that out into the community and enjoy that holiday for whatever it meant for them was great. So I've been at SARC ever since. Um I have not left the community school program. Uh, so we serve um students as young as 15 months through five years as a in as a preschool. Um, but that's how I I got started uh in the field. And and uh yeah, I just love it.

SPEAKER_00 5:29

Yeah. So you were one of the lucky ones to just have the stars align where you were in a facility that focused on that with PRT infused, right? So that has been your experience. That's incredible. I'm very jealous of that. I wish I would have known of places back then that were doing this because it's just such a different world for me now as I support children and support families, and just moving into kind of the NDBI arena, which is where I've been hanging out for the past 10 years or so.

unknown 6:00

Uh-uh.

SPEAKER_00 6:00

Um when you think about NDBIs, uh how has it influenced your professional development uh journey? So yours might be a little bit different because that has been your journey from the get-go. And think of anything that you guys are doing with NDBIs, how immersed it is within your mission, vision, and values, which is incredible, what that would look like for a program if you didn't have that. Does that make sense? So, like when you see other community programs, maybe do you see a difference in how staff are enjoying the work, how children are being happy with the services they're getting, like like a comparison point?

SPEAKER_01 6:46

Yeah, I mean, I can I can definitely uh first speak to, you know, how it's influenced my professional journey. Uh, I think, and I think a lot of this will um kind of answer the second question by default as well. But I think first and foremost, I just have a strong appreciation for evidence-based practice. Um, and that's something um that uh SARC is very committed to and um that we never lose sight of. So I think that's really important, especially um, you know, for a lot of families and those who are receiving a first-time diagnosis. You know, you do a group, a Google search for autism treatment, and you can't even get through all the pages, you know. Um, and so uh I think being able to be a lifeline for families and provide them with that information on evidence-based practice is really key for their journey as part of their journey.

SPEAKER_02 7:43

Absolutely.

SPEAKER_01 7:43

Um I also um love being involved in a program that includes typically developing children. Um so as much as I love the outcomes we create for our students with autism, uh, we are creating friendships between all students. Um, so supporting an inclusive community for our students without autism who will one day grow up to hopefully support an inclusive community themselves within their family or their workplace. Um, so I think that's um probably the most, my most favorite part uh of our program as well. Um, and then I think also just the uh passion to teach uh foundational skills, um, you know, which is the the core of NDBI is to help teach uh learners to um soak in all that they can within their environment and have those key skills for learning. Um and so I think, you know, teaching them to be their own advocates, communicate their preferences, and be able to seek out um what they want to from their environment and use it is uh just a great way uh for that intervention to be applied.

SPEAKER_00 8:56

Yes, and what an incredible support for their autonomy and thinking about advocacy, self-advocacy. And so in the community school program that you have, there's a preschool and you have an inclusive preschool. Is that on site there at SARC? Or do you guys partner with local facilities for preschools?

SPEAKER_01 9:14

Yeah, good question. So um uh we are our own private preschool. Um, so we are licensed through the state of Arizona. So um we have also multiple locations around uh the valley here in Arizona. And um we operate as a preschool, um, but we are also an intensive ABAs program for students with autism and without autism. So our typically developing peers are attending to access the preschool model, uh, while our students with autism are not only attending for the preschool model, um, but also to receive that intensive treatment. Uh our model, uh the community school model, is rooted in pivotal response treatment. That was brought over from our CEO, Daniel Openden, who has extensive training in PRT. Um, and what we realize very quickly with the age that we serve is that being trained and versed in PRT doesn't automatically give you a training and skill set on how to run an inclusive preschool that utilizes naturalistic teaching like PRT. Uh so what we did was we designed and developed a model loosely based on a lab school at Emory University called the Walden model. Love Walden. Um, and over the years, we continued to create meaningful outcomes for our students. Um, everything was growing going great, but then we realized, you know, as um our enrollment was getting younger and younger in age, and a wonderful thing, right? Early diagnosis, we were missing something. Um and so that's when we decided um to infuse early start Denver model um there into our school. So that came from our chief clinical officer, um Rachel Anderson. She sought out her certification, um, brought me along into that journey. And um, so now we've infused it together um into our preschool program.

SPEAKER_00 11:17

Great. And have you seen a big difference with that with the younger children, kind of bringing in some of the ESTM techniques? You know, PRT is so infused within ESTM. So kind of some of the nuances of the ESDM, I think, are really helpful. And I love the group ESTM research that's coming out with some of their settings. So I'm not sure if you guys would be infusing group ESTM or if it's just ESDM principles within the preschool setting.

SPEAKER_01 11:44

Yeah, yeah. No, I remember um very early on in my career going back and talking about the impact of having early Start Denver model in our program. Uh, while we were feeling very confident in our PRT implementation, we had this aha moment when we realized we didn't quite have it matched up to developmental appropriateness for one of our clients. So um we had a three-year-old, and you know, we were getting very um uh contingent expressive vocalization uh sounds um to request. You know, it was like an ah sound every time we were feeling great about it. And then we're like, well, let's try and get some sound variation here. And um, and then we really tried to push for that um with his favorite food. Talk about motivation, right? Everyone loves a good Oreo and um, you know, you'll be really motivated um to vary your sound to request for that Oreo. Um, and we got stuck. Um, and uh then he stopped wanting the Oreo. Um, and then we realized we're missing these foundational skills, we're missing the prerequisites, and that's really where Early Start kind of saved us there. Um, is we needed those foundational skills for our learners. Um and starting, um, we can, I mean, we can weave Early Start Denver model into any age group, just kind of develop depending on the development skill set where they're at. But really for our very young language learners and um and our 15-month-old to like one and a half year old or two early to age group, um, we've just seen tremendous outcomes as they continue their journey with us. Um, and they're we're able to um tackle, you know, the generalization component. We don't need to teach discrete skills, we're not finding the splintered or fractured skill set more. We're kind of covering all those bases. So that's been tremendous.

SPEAKER_00 13:44

Yeah. Do you have any examples? I love to hear that tremendous progress and the outcomes because that's the same thing that I encounter when I support children. It's just rapid with how fast everything seems to fall into place, which I know is not very scientifically described. Do you have examples of outcomes that you guys are kind of tracking over time with engagement or communications, social interactions or social communication?

SPEAKER_01 14:12

Oh man, um, you know, we we've gone back and forth on a lot of different things. Um a couple of things that um, and and we are hoping to one day also put like gather a bunch of research and and actually um publish it, but that's probably farther down the line. Um I would say one of the bigger assessments that we do is called the preschool language scale um assessment. Um, so we do that for all of our students um right at the onset of treatment, and that kind of follows them uh until discharge. Um and I think that kind of speaks volumes to the progress. So we had um a couple of students, and and at this point it's becoming handfuls of students over the years that start uh with a comprehension and expressive language level, you know, between four and six months. Um, and after 10 or 11 months of treatment, um, they've doubled um their age. So they're now, you know, right under age equivalence, but they are surpassing time in regards to the progress that they've made. So now they've bumped up, you know, in 10 or 11 months, they've gained 20 or 21 months of um comprehension and expressive communication skills. So we're seeing that more and more now that we have um made that um adjustment to incorporate early start Denver model.

SPEAKER_00 15:45

That's incredible. The kiddos that come into the preschool program, are they learning from the group instruction and then there's some one-on-one, or is it like a hybrid approach where they get a little bit of both?

SPEAKER_01 15:58

Yeah, good question. Um, so um within the context of our preschool model, um, that's 20 hours a week. Um, that is in a four-to-one service delivery model. Um, so for every four students, there is one um clinician um in the classroom. We have um up to 16 children in each classroom. Six of those children have a diagnosis of autism, and the other children do not have a diagnosis of autism. Um, and in a traditional preschool model, you might see like one lead teacher with one assistant. Um, so we're different. We have a designated clinician um within each zone of our classroom. Um, so our classroom setup um is unique. Um, we have two main sides of the classroom, one that's a more structured side, and then one that's um more unstructured. Um and then within each side of the classroom, it's split into designated zones. Um and each zone um has its own unique goal and purpose. Um, so one of those, for example, I think one of the more popular ones that everyone can relate to is circle time. Um, circle time, a great large group activity. Uh, we sing, we read books. Um, but back to your initial question, um, you know, we have one clinician who's running the circle time activity. So they're in front of the group of kids, they're singing, they're reading. We would expect all of our learners to be attending to that clinician running the activity and gaining um, you know, the skills and their learning opportunities incorporated within that activity. So the lead clinician who's running the activity is responsible for running the show. They're providing varied opportunities for learning, passing out materials, so some great social opportunities. Maybe it's a shape book. So they get exposure to different shapes or colors of the shapes, some motor imitation, um, so responding to instructions. Um, and this is where another unique part of our program comes into play. So the clinician who's leading circle time is um having one um unique interaction with each learner per minute. That's called our contact model. Um and they are being contingent on those learning opportunities. So I think in a more traditional preschool model, you get what you get sometimes, right? Um, but they will um provide and support that contingency there to support that learning opportunity that they've set up and facilitated. Um and so um that's a little bit about you know, circle time and an example of how um our model runs.

SPEAKER_00 18:53

Yeah, and I love it. I'm thinking, I'm envisioning quadrants like very close, right? And you have this area here, and the clinic we had in Las Vegas was very much set up like a preschool or a daycare where you would have centers, and only so many children can be in a center, right? So we can work on transitioning, uh center is closed, work on gratification, tolerating that it's not open. These are all things that our children would encounter in those settings. Certain materials were placed in certain centers, so they bode very well for certain types of learning objectives to focus on. So within like ESTM, it's such environmental arrangement and kind of thinking and planning is so intentional and it's such an important part of the model. And it makes such a huge difference when you have a well thought-out design space. I love the idea of the quadrant kind of unstructured and structured. I think that's a really creative. And that goes back to Walden, or that's your spin.

SPEAKER_01 19:52

Yes. No, that's definitely a Walden is kind of having those designated zones throughout the classroom. Um, so yeah, we have circle time, um, we rotate through different uh small group activities. Um, I think to your point, you know, sometimes the activity is full. You have to wait it for your turn, you have to find an alternative activity to do while you wait. Um, then we have a great playground space for recess. They eat lunch and snack together, great opportunities for some social conversations. Um, and then uh free play, um, which is more of that choice um zone where we have a bunch of toys uh um falling within different developmental domains and categories to support some of that more unstructured play that's still really important, but you know, you don't have someone kind of giving you the materials and telling you what to do.

SPEAKER_00 20:48

So yeah. So following back up on that, the 20 hours the kiddos are there, do they also get some other support services or they on average kind of come in for that preschool program 20 hours a week? Or is there more?

SPEAKER_01 21:04

Or depending on So it uh they are required um to be with us for the 20 hours a week in that um group treatment model. Um now after our preschool ends, um, so we're a morning uh program. So in the afternoon, that's typically when they're accessing other services. Um so we have some of our um clients accessing um, you know, OT or speech. Um, and then we we also offer uh one-to-one sessions. So um we are able to provide one-to-ones in the afternoons, and that's where we're able to supplement on maybe some of the skills that we're we're seeing some challenges in the morning or um skills that we're not able to target because it's not appropriate in the preschool. So teeth brushing support, um, getting into the home and supporting the family, following some household rules, um, interactions with siblings. So we ask uh, or um it's mandatory for a minimum of six hours a week to be in the one-to-one, um, but up to 12. Okay, great hours.

SPEAKER_00 22:11

And then parent training, parent support, parent coaching part of the uh yeah.

SPEAKER_01 22:16

So we um conduct parent training a minimum of five hours a month uh for uh every enrolled uh family, uh a couple of different formats that we conduct parent training, um definitely in the home and community, um, and you know, picking out, selecting their significant goals, um, working on their implementation of pivotal response treatment. I also love working out of the early Start Denver model books with them to really help support their child's communication and social skills. Um, and then other than your more formal progress review meetings, we also do what we call a guided observation where we zoom the parent in in the classroom and they're able to watch their child in action while the BCBA is guiding them through all the intervention that's occurring and the um socially significant goals and interactions that they're having. So that way the parents can see it in action, learn more, um, and then learn strategies to apply it into the homework community as well.

SPEAKER_00 23:22

That's incredible. I love the thought of them having that kind of fish lens, kind of zoomed in view of wow, look at how my child is doing interacting, and they're out of, they know they're in that program for 20 hours a week, and we get a glimpse into what they're doing. And I'm sure that must be very validating for parents to get to see their child having those interactions and then also, like you said, learning and how to integrate it or support their child better at home if they're noticing some things that they could benefit from. So that's really cool. I love that.

SPEAKER_01 23:53

Yeah, I think it's especially helpful and important our pre-K year. Um, we actually have uh draft goals for parents and looking at levels of support for their child within each of our designated zones to help with that transition to kindergarten because the parent can say, you know, I've seen my child during a small group activity, completing a worksheet, having a meal time around others. And here's where I've seen support needed, and here's where I have seen my child be very successful with minimal to no support. So as they're looking at kindergarten um placement and options, they're speaking from firsthand experience instead of having the BCBA sort of speak for them or represent for them. Um, so I think that that during that year in particular, it's really important.

SPEAKER_00 24:42

Yeah. And not only are you guys supporting the children to, you know, self-advocate, you're really helping the parents to become advocates for their child's education because they feel confident and knowledgeable about their child's strengths or areas of need, and they can articulate that and firmly advocate for that for the different placement options that you guys mentioned. That's so exciting. I didn't know about that. I had read a little bit, but that's new to me. So that's really cool. Can you think of any advice that you would give practitioners who might be listening who are dabbling in NDBI or learning NDBI and starting out? Anything that would be helpful for them to know? Any resources that you can think of to share that we could link up with them so they can continue to learn and evolve their practice? It's almost two questions in there. Sorry.

SPEAKER_01 25:36

Yeah, yeah, yeah. No. Um, so my first piece of advice, I actually learned the hard way this week. So um funny story. So I was uh working with a two-year-old um who is demonstrating some difficulty during recess. Um, so he likes to kind of find a spot and sit while all his friends are, you know, up and running around and going down the slide and the coaster. Um, and he likes to sit and pick at the rubber on the road. Um, but I noticed that um, you know, during my initial observations and trying to design my intervention, I was like, he loves circle time. So I have this vision. It'll be great. We're gonna make a circle time songbook and we're gonna sing about all the fun activities and we're gonna walk by the activities, use a shaping procedure, you know. Um, but he's gonna be having so much fun, he won't even notice, right? He's he's gonna walk around, he's gonna love it, he's gonna match pictures, we're gonna sing. Um, day one, we brought out the songbook, uh, little bit of interest, but was very much like, no, thanks, don't want it. And I was like, okay, we're gonna give it another shot. Day two, we brought it out. Immediately started crying. And I was like, I was just so offended. I was like, you love circle time, you love songbooks. Uh, what's going on? Um, so I think that leads me to my first piece of advice is don't be afraid to abandon your own good idea. Um, it's so important. Um, I think I love the creativity of our field, but I think sometimes um we can kind of get stuck, right, with um what we think is important or what we think will work. Um, but really listening to the individuals that we're working with is so important. Um, along similar lines, um, which I thought I was bringing was is a fun factor. Don't lose the fun factor. Um, bring your most ridiculous self forward, find the smiles, um, and and just enjoy, enjoy it. Make sure the individuals you're working with are having fun while they're learning, while they're picking up the skills that they need to. Um, and then lastly, which I think kind of leads into the resources part, um, for me, um, and because um when I first started in community school wearing two different hats of not only um a therapist and then a behavior analyst, but also an educator, I had no schooling on early childhood development and education. I I knew really good ABA, right? I could pull out anything, but I didn't know how to tie it into developmental appropriateness and find that. So I think um being able to recognize that and then um continue to pursue uh research um on development. So based on who you're working with and the ages that you're working with, just really make sure that you know what is um developmentally appropriate for them.

SPEAKER_00 28:48

Yes, and I'm gonna add some links to our show notes. And I am sure that there are some free child development courses on that. I know I have a few books, so I absolutely agree with you. I didn't have that experience. I think a lot of behavior practitioners who are coming out aren't aware of child development and kind of have a background and theory of that, and that definitely impacts what is developmentally appropriate within our practice to work on. And I view supporting young learners as almost a sub-speciality. Like a two-year-old is very different than a three-year-old and is very different than a four-year-old. And it really helps to understand what is appropriate or what is expected or typical of a child at that age. And there was a great article, I'm gonna link to this, that just came out about neurotypical behaviors at different age ranges, and it really kind of highlighted for me uh some of the goals that we are writing, near zero occurrences of tantrums for a two-year-old. That's not developmentally appropriate, right? They should be having tantrums. We would expect them to have that at that point of their life as they're becoming more independent and identifying their own interests and using the power of their voice. So I think that's a wonderful article that behavior analysts who are working with their young children should read and review because it really puts a focus on what neurotypical children are doing, right? Our children kind of need to follow that same kind of developmental trajectory. They might just have little detours along the road. So I think those would be wonderful resources to add to here.

SPEAKER_01 30:27

Um, that's so funny. I wonder if you are talking about the article that I was actually going to recommend as well. Is it the behavior norms in neurotypical children from 2023? Yes. And I thought it was great. A colleague actually shared that um with us recently because it looks at aggression and biting and the delayed gratification, being able to wait, um, and what that average is. And it's perfect because yeah, if we're writing a mastery criteria for zero occurrences, but actually it should be about four, is what is developmentally appropriate, then we've got our mastery all wrong and we're never gonna hit our goal. So um I love sharing that with parents as well, um, especially with the age group I work with. Parents ask a lot of the time, like, what's what's toddlerhood? And then where's where does the autism come in, right?

SPEAKER_00 31:20

Yes.

SPEAKER_01 31:20

Um hard sometimes. But that is definitely one that I've been obsessed with recently. Um, another one um is the Hawaii early learning profile, um, or called the help charts. Um, that's another great one. Um, and then I also thought, so because we are a licensed preschool, we've been able to partner with Quality First. Um, and that's a program in Arizona that is uh funded by uh Tobacco Revenues, um, and it's geared towards improving the quality of early learning programs. Um and they've been a wonderful resource for us. They have their own curriculum and resources on developmental milestones. And so I wonder, based on the state, if there are similar organizations that have the same mission and desire to help, you know, in this case, preschools, but if there are clinics that kind of serve both those roles, like we do, um, accessing what your state has as well, because they've been amazing. And and uh I think it's been very mutually beneficial for them to work with us to help understand like what does inclusion look like? Um and then how can they bring that to their other preschools, you know, who have students with um varying learning abilities and whatnot, um, whether you know the kiddos are diagnosed yet or not, they're running into some of the same challenges and need for, you know, group-based interventions and supports and group management. So um having that partnership has also been um really key for us. But again, it goes back to understanding development and they've been able to help us um there.

SPEAKER_00 33:11

Incredible. I'm gonna definitely link that and I'm gonna do a little bit of a search to see if that is a program that has an equivalent in other states that people can kind of look for this, or these are key words to search for if you're looking for something to have that kind of a partnership, which would be an incredible resource, right? You can't be an expert in everything. And one of the things that I love about the ESDM is that really multidisciplinary approach. You should have all of these amazing professionals kind of meeting of the minds to help guide us within child development, speech development, OT type related um skills. And I think it's incredible too. I really truly feel that it takes a village to raise a child. And there was something where it was like, do I call the number? Do they just show up? Like, how do we make that happen? And and you guys seem to have a really nice connected village over there in terms of all of the supports that you're able to offer to kiddos that you serve and and likely the greater community as well. And I love the partnership that it's very bi-directional. You're helping one another, they're helping you. That's great. Yeah. Thank you so much. This has been so incredible to have you on here. And I can't wait to link all of these amazing resources so that everyone can learn more about what you all are doing, the research coming at SARC, as well as some of the really cool resources that you've shared. And I appreciate your professional advice to people who are starting out. I think that puts such a wonderful personal touch on it for them.

SPEAKER_01 34:43

Yeah, thank you so much for having me. It was great.

SPEAKER_00 34:46

You're welcome. Thank you.