ABA Staff Training

 

I LOVE staff training. Its one of my favorite parts of my job. I value staff training so much because as a BCBA I could come up with the most innovative and technically sound treatment plan out there, but if the direct staff under me do not properly execute, then whose fault is that? I believe its my fault. Part of my job is to properly train and supervise direct staff, and also to evaluate staff as being a good fit for the demands of the job. When I train direct staff, I am giving them the tools they need to be excellent at their job. And who wants to feel that they are excellent at their job?? (the answer is everyone)

Training is such a critical issue in this field, because of the tiered service delivery model. The professionals who are credentialed to run or supervise an ABA program (e.g. BCBA), typically do not staff ABA programs. There are many reasons for this, but I'll name 3: (1) The demand for ABA staff FAR exceeds the supply (2) BCBAs are expensive (3) The tiered model frees up a BCBA to have a larger caseload.

 When working with or collaborating with other professionals (like OTs or teachers) they often ask me who can provide ABA therapy. Well unless licensure is required in your state/local area, anyone CAN provide ABA therapy, but should anyone do it? Definitely not. 

The BACB is currently moving towards a certification process for direct level staff, but in my experiences ABA therapists are typically college students with little ABA experience. These individuals will require extensive training and support once they are hired.

ABA therapy isn’t complicated, but its not easy. A quality supervisor and excellently designed treatment plan can be implemented by almost anyone. When I first started in this field, I knew nothing about ABA but I was intensively taught (and closely supervised) to implement skill acquisition programs and behavior plans, collect data, and generalize skills across environments. The problem is that far too often, therapists are hired without a supervisor. 

Or the supervisor is insanely overworked and stretched too thin, and their quality of supervision suffers. 

Or unscrupulous ABA therapists offer themselves out to work for families independently, and falsely present themselves as being more knowledgeable than they actually are. 

Training is, in my opinion, one of the most pressing issues in the field of ABA. Families are hiring ABA therapists directly to avoid the high cost of agencies, but they don't understand the importance of hiring a supervisor for that therapist.

Parents please don't feel like I’m picking on you. I see this issue happening in schools as well. School systems with minuscule financial budgets, but plenty of children on the spectrum, often place individuals in the role of Behavior Specialist or Autism Expert, who really should not be in those roles. Anyone implementing ABA therapy can teach a variety of critical life skills, such as language, toilet training, and strategies for problem behaviors. If someone has marginal or poor quality training, they could cause a lot of damage. They could inadvertently teach or strengthen inappropriate behaviors, that a qualified professional will then have to come in and "un-teach".

The BACB Guidelines for ABA Treatment  provides the following recommendations for hiring and training Behavior Technicians (ABA therapists):

Minimum hiring standards: High school degree minimum, AA degree preferred, pass TB test and criminal background check.

Minimum training standards: Pass initial competencies composed of both oral and written scenarios as well as direct observation, demonstrate ability to correctly respond to treatment protocols, receive case assignments that match their skill level and experience, and receive both initial and  ongoing training and supervision from a Behavior Analyst.

Training content: Should include CPR, HIPAA and ethical behavior, mandated reporting, ASD knowledge, data collection, basic ABA procedures, and developmental milestones.

The BACB Guidelines refer to a minimum standard. Having been in this field for many years, I can say that some agencies provide excellent initial training, and some...…don’t. I strongly believe that often the high turnover rate in this field is due to staff burnout, which is what happens when poorly trained and low paid therapists are sent into situations they are not prepared for.  E.g. The therapist spends a session getting headbutted repeatedly, and abruptly quits.

High turn over impacts everyone negatively, most importantly the individual receiving treatment.  The importance of putting time, money, and resources into giving new staff quality training can't be overstated.

I have conducted and created staff and parent trainings, and from my experiences as well as my review of research, here is what does and does not work when it comes to staff training:

• Didactic training (lecture) just isn’t enough. Training should also incorporate feedback, rehearsal, direct coaching/modeling, and hands- on experience. Training should also be modified to the needs of the trainees, the situations they face, the type of clients they serve, etc. I see far too many "trainings" that are just giving of information. Meaning, a lecture or Power Point explaining a concept. A person hearing about a concept does not mean that person now knows how to apply that concept. Training must be designed to teach a concept to competency, not just give out information.
• Pre and post tests are often helpful to evaluate effectiveness of training, as well as provide information about individual deficits that can be targeted during on the job training
• Any adult learning should incorporate active discussion and encourage questions/participant comments, rather than a model where learners passively sit and listen
• Numerous studies have shown that the mere training of skills to direct staff is insufficient in maintaining a steady performance of those skills. In other words, just because I teach the concept of reinforcement to a therapist does not mean they will successfully implement reinforcement when working in a clients home
•  I know many companies who use a training model of “shadowing”, which would include following an employee around as they go into the field to work with clients. That method alone is not sufficient to properly train staff, and will likely not lead to maintenance of skills learned over time
• Organizational Behavior Management strategies, such as self management procedures, are empirically supported to improve and maintain staff performance. For example, a therapist could track her accuracy with delivering quick reinforcement, and then review this data with the supervisor
• Supervisors need to regularly directly observe direct staff, provide specific praise and feedback, performance modeling, and set clear expectations for improvement

*Staff Training Resources

Arnal L., Fazzio D., Martin G. L., Yu C. T., Keilback L., Starke M. Instructing university students to conduct discrete-trials teaching with confederates simulating children with autism. Developmental Disabilities Bulletin. 2007;35:131–147.

Catania C. N., Almeidia D., Liu-Constant B., Digennaro Reed F. D. Video modeling to train staff to implement discrete-trial instruction. Journal of Applied Behavior Analysis. 2009;42:387–392.

Downs A., Downs R. C., Rau K. Effects of training and feedback on discrete trial teaching skills and student performance. Research in Developmental Disabilities. 2008;29:235–246

ATS Resource: Creating Training Programs that Work