Toward a Conversational Murmuration
There’s a conversation being repeated ad nauseam in various corners of society for individuals who are concerned with autism, and maybe even some who are not concerned. What does ABA do? Does it work? Under what conditions? Is it worth it? Parents are asking. Funders are asking. Policy makers are asking. Professional organizations are asking. Clinicians are asking: What is happening with the quality of ABA services? What is to blame?
I offer these for initial consideration:
The Jobs.
Are ever growing salaries reinforcing mediocrity? Are questionable billing practices incentivizing fraud? Are the low-wages and high-stress environments for RBTs increasing turnover? Are poor intake processes haphazardly pairing clients and clinicians? Are providers operationalizing one-size fits all intensity of hours per week?
The Training.
Do we need a residency program post-degree or post-certification? Are supervisors poorly equipping their supervisees? Are the graduate programs teaching transferable skill sets? Should practitioners have greater influence on graduate training? Is academia graduating academics, or practitioners? Do we have enough mentors? Is specialization in certification needed? Is the demand for growth louder than the voice of quality?
The Standards.
Is it lack of standardization of care? Do we even have agreed upon outcome measures? Field-specific, standardized and validated assessment tools? How applied is our research? Who is the audience of this research, and who is the beneficiary? Cui bono?
The Consumers.
Are parents being shaped to believe “something is better than nothing?” Are families so afraid of losing services that they do not report a multitude of issues?
The Practice.
Do we practice with cultural humility? Can we agree we are not omnipotent — that we don’t know all there is to know about all things “behavior?” Are we collaborating and coordinating care?
The Outcomes.
Have we removed the terms “recovered” and “cured” from our verbal behavior? Are we engendering self-advocacy? Have we embraced promoted neurodiversity in society? Is Quality of Life the superseding goal of care, or we just teaching to the test from assessments and curriculums loosely tied to daily functioning?
The History.
Have we acknowledged our wrongs? Saved grace for our best intentions? Vowed to do better? …
That’s a lot of questions, I know. But they’re increasingly common. And while this list might be exhausting, it’s certainly not exhaustive.
So, what needs to be fixed “first?” (Chicken sneers at egg; Egg glares at chicken).
The answer is it is ALL of these things. There is no “first” because we have not arrived to this place in a linear progression. The convergence of all of these factors has resulted in sub-standard care. It matters not, who or why or how, but that we all agree to act, and to do so collectively and selflessly — because all of this… ALL OF THIS field, practice, literature, data, industry, market, career, educational path, billing code, payor division… every title, every degree, every license and certification has been built on the backs of people and families who desired help.
During this Great Resignation, I am seeing countless clinicians turning away from their jobs, some even moving away from autism supports and into far corners of the science of ABA, or in other cases abandoning the field all together. To say I don’t understand the inclination, would be untrue. But I’m here to stay. I want to help. That’s why I got into this field in the first place (Egg smiles at chicken; Chicken blushes).
I think I have some other the answers, but I’m going to call on some of my more astute colleagues to respond to this essay with their particular keen eyes in various areas. I will be posting their contributions to the discussion on this blog, in hopes of creating a conversational murmuration towards bettering our services for the people that matter most — the clients.
[If you are interested in writing a response piece to be posted here, please let me know at amandajralston@icloud.com]
Q: What is a murmuration?
A: Click Here.
