Sprinter vs. Marathoner

"A sprinter body is built for speed and power while the marathoner is built for long, slow endurance" - From www.livestrong.com article 

If you supervise/manage ABA cases for any period of time, you will start to notice a phenomenon I like to refer to as sprinters and marathoners.

Sprinter clients are often SUPER excited and energetic about starting services, and just want to hear about your success stories. When you first meet them, you will probably think "Wow! What a great family, I can't wait to start working with them". Sprinters are often the "1, 2, 3, ... Magic!" people.

Marathoner clients aren't quite so dazzling upon first meet. They are happy to start services, yes, but they may be more cautious or skeptical. They may admit they aren't fully sold on ABA. They might quiz you or question your expertise in a way that makes you a bit uncomfortable.

Just like the tortoise & the hare, looks can be deceiving here. Time and time again, I watch sprinter clients start out strong and then fizzle out or hit that dreaded wall. Maybe their child got kicked out of *another* daycare, or the biting behavior from years ago came back, or toileting turned out to be harder than anticipated. When the path begins to veer or curve and obstacles pop up, sprinters start to slow down, or might just come to a stop. Followed by completely disengaging from the therapy process. 
Meanwhile, my marathoner clients often start off slow or bumpy, but they keep a steady and consistent pace, even when things get crazy hard. They understand that therapy is a tiring, ongoing, up and down journey, and not so much a race.


ABA Supervision

Being an BCBA/ABA supervisor means you have a role that you cannot execute alone. The caregiver/parent being on board is critical in order for you to do your job. All the typical supervision duties (assessment, evaluation, program writing, coaching/training, data based decision making) require parent input, parent approval/consent, or parent implementation when the treatment team is not around. Once sprinters burn out and collapse, it will affect the entire team. 

Parental disengagement (the "checking out" process) can lead to staff burnout, supervisor burnout, inconsistent treatment gains, resurgence of problem behaviors, and could put the BCBA supervisor in an unethical position (see ethical guideline 2.15d). It is the ethical obligation of the BCBA to ensure that the client is benefiting from treatment. If parental disengagement is preventing that from happening, then that's a serious problem.

Sprinters

Not sure what a sprinter typically looks like? Here are some common characteristics:

     Over the top excited at the start of services/only expect good things from therapy, view the team as all-knowing experts, unrealistic expectations of treatment, overly attached to staff/wants to develop friendships, give little input/ask minimal questions of the team (“Whatever you think is best”), avoids talking about or facing child’s deficits, avoids discussing the future/planning for long term goals, minimizes or downplays problems or issues, overly confident in their own abilities to execute techniques, approaches treatment like let’s throw stuff at the wall and see what sticks, cannot tell you why they chose ABA/low commitment to the process, overly focused on the end of the race or The Finish Line

1 or 2 of these characteristics does not necessarily equal a sprinter. It's the combination of multiple characteristics, combined with telltale signs of parent burnout or lack of commitment that reveal a sprinter.

Marathoners

Not sure what a marathoner typically looks like? Here are some common characteristics:

     Has an appropriate level of fear or skepticism at the onset of services, maintains realistic goals, asks probing or challenging questions of the treatment team, openly voices their opinion/will tell you when they don’t agree, comfortable setting both short and long term goals, may be involved in multiple treatments but understands that ABA requires high commitment, wants to participate in therapy/asks to be trained, openly admits to struggles or difficulty implementing the techniques, asks treatment team to help them advocate in other settings, rooted in reality vs focusing on a future day when everything will be fine, celebrates small successes or the baby steps of progress

     1 or 2 of these characteristics does not necessarily equal a marathoner. It is the combination of these characteristics, combined with consistency when the treatment team is not present that reveal a marathoner.

Action Steps

As the BCBA/supervisor it is common to want to blame yourself when a parent suddenly disengages, checks out, or begins to actively derail/resist the treatment process. This blame isn't just non-helpful, it could lead you to a place of frustration and burnout. 

What is key, is putting strategies in place to prevent sprinter issues rather than trying to react to them once they're already happening. Think antecedent interventions: what are procedures that can be implemented right from the start to help prevent a case from falling apart gradually, or suddenly. 

Procedures like:

• Company policies such as careful screening/ interview of new clients, an intake process that clearly outlines parent expectations, a parent involvement policy (one that is actually enforced, not just written on a piece of paper), well trained staff who can recognize signs of burnout in the parent, and supported clinicians who are equipped to set the parents up for success.
• Always view the parent as a vital part of the treatment team. If the parent bursts out of the gate at a sprint, only to collapse shortly thereafter, then the whole team needs to help get that parent back up and on their feet. This is everyone's problem to help solve.
• At every phase of treatment, continue to review anticipated response effort and commitment levels with the parent. For example, when I introduce behavior plans or implement toilet training protocols I make it very clear to my clients that we are about to roll up our sleeves and work hard. I don't sugarcoat or minimize the increase of effort they are about to enter into, because I don't want that to be a nasty surprise.
• Lastly, know when to terminate services. Termination is not a dirty word. It may just be the best choice for the client, particularly if due to persistent parental non-adherence to treatment. If any gains or successes are only demonstrated when the treatment team is around (aka behavioral contrast), then is that really effective treatment? I don't think so.