A Values-Based Company
Description
ABA Across Environments is a small company with fewer than 20 employees that is based in Colorado Springs, Colorado. Over the course of practice, processes and practices began to shift towards a values-driven model that promoted flexibility with individualized training and scheduling that were based on individualized self-assessments from one-on-one meetings. These meetings allowed for feedback to be reciprocal and rooted within the company’s and the employee’s values so that actions could be taken that better supported the person as a whole. We are dedicated to providing an experience that is rooted in the family’s values and diverse cultural backgrounds as well.
Introduction
ABA Across Environments is an in-home ABA provider in Colorado Springs, Colorado. Services began the summer of 2018, and the company grew as prospects were referred for services, and recruiting was done via peer referral or large cattle-call style interviews. However, in the summer of 2020, all client-services began to shift toward person-centered and trauma-informed care within the framework of Acceptance and Commitment Therapy (ACT). ACT is rooted in Relational Frame Theory (RFT) and allows for considerations based on the context of the individual (Villatte et al., 2019). Measurable results can be attained and within each given context there are opportunities to 1) behave toward a self-determined set of values, 2) engage in mindful practices that help focus on the here and now rather than the past or future, 3) explore how one interacts within the context, 4) learn how to accept the things that cannot be changed, and 5) find separation between thoughts and context.
The cornerstone of ACT, Psychological Flexibility, incorporates the areas of values, committed actions, self-as-context, present moment awareness, diffusion, and acceptance. Within practice, implementing Psychological Flexibility as a skills-based and as behavioral response strategies has shown to dramatically decrease challenging behaviors across clients and learners within sessions. Conclusions drawn from the effectiveness of utilizing ACT with children led to the possibility of applying those same principles within the organization’s management strategies. Supervisees enrolled in a Graduate Program with an emphasis in Applied Behavioral Analysis were the first to be taught how to apply the principles of ACT within their own lives. From there, the same strategies were used to guide the training and growth of all employees. The results indicate that ACT is instrumental in helping ABA Across Environments organize a flexible company culture that honors its employees, allows for the company’s sustainable growth, facilitates the employee’s individual growth and retention, and achieves overall improved client outcomes.
The first shift toward building this approach in operations began by creating a Registered Behavior Technician® (RBT®) Advocate position to serve as a liaison between the direct line technicians and the clinical and administrative teams. This liaison, who is also a peer, meets one-on-one with each employee to help provide critical feedback to the supervisors without the fear of supervisor bias or employer retaliation. More than human resources, the RBT® Advocate provides a safe space to express concerns, raise questions, and offers solutions without the involvement of the BCBA®, clinical director, or any other person able to make decisions regarding compensation or tenure. The RBT® Advocate engages in and models Psychological Flexibility to help resolve training issues, as well as support client-RBT relationships, caregiver training, and corrective actions.
How It Happened
None of this happened without error. In fact, many errors occurred. For the employers, ABA Across Environments had little care for employees’ personal schedules or values. Scheduled hours were based solely on the hours of operation and consisted between 30 to 40 hours each week, and exclusive of a minimum 30 minutes’ drive-time between clients. Staff members often reported having to speed between sessions in order to make it on time. Schedules were loaded from 8:00 a.m. until 6:00 p.m. Consequently, personalized training was minimal and expectations for autonomy were unrealistic. Turnover was high with at least one employee leaving once every two months, and assessments were not consistently occurring across former supervisees to determine why. Hiring new employees, as well as onboarding new clients, was illogical in that there was little standardization across hiring or training processes to account for quality of services provided. Leadership was mentally and physically exhausted because it was spread thin bouncing from fire to fire as troubles arose across clients and staff.
Quality of services was a claimed value; although merely stating that did not align with the actions being taken by leadership. This was evident by client satisfaction, supervisee satisfaction, and overall client progress. After reflecting, the leadership recognized that to be an ACT-practitioner requires incorporating the practice across all aspects of work and life. Practitioners must dance the psychologically flexible dance to teach others how to do the same. Essentially, ACT-practitioners cannot just push another person to practice ACT without utilizing those same principles across all aspects of their life and how they prioritize organizational structures to support this for their supervisees.
Leadership began exploring their own values as well as the company’s core values, its methodology, and its implementation of policies and procedures. After assessing the company’s values, three core values were determined: Quality, Compassion, and Honesty. However, further examination was needed to determine the staff and client’s perspectives of ABA Across Environments’ actions as they pertained to values and practices. Surveys were initially implemented, but few responses were received. Thus, in-person interviews with the goal of gathering quality feedback that could result in actionable change were conducted across caregivers and staff. Self-assessments were created to help develop careers while allowing leadership to delegate and remove some root of the burn out. And one-on-one facetime allowed for candid feedback which allowed for better outcomes when surveys failed. These open-ended conversations provided a compassionate space for feedback to be given, barriers to be expressed and addressed, personal values recognized, and plans to allow for advancement within the company while allowing for a healthier work-life balance.
In addition, these discussions inspired several new positions: the RBT® Advocate whose purpose is to help others, specifically peers when they feel offended or provoked; the Peer Trainer who values organization and training; and the Scheduler who values flexibility and helping others. Furthermore, several supervisees expressed the desire to become a BCBA®. Each new position came from a place of need and an area of struggle for the company. Tasks that seemed impossible or burdensome to some of the leadership team proved to be within the scope and values of a supervisee and consequently more easily delegated.
The meetings also allowed supervisees to express their own struggles with disengagement. This indicated that from an employee’s perspective, implementing psychological flexibility needed to be better modeled by leadership or trained how to use to address challenging situations. Areas that needed to be addressed were that many employees simply could not work certain hours during the day or needed a day off to schedule personal appointments. Others needed more time off in the morning to adjust for self-care needs. Others wanted more time with their own children in the afternoons and early evenings. Although schedule modification was difficult, it has proven to be sustainable and effective in that employees feel comfortable taking the time off needed to rest and care for themselves. That in return, has enabled better quality services.
How is Across Environments Different?
When Across Environments was established in 2018, my goal was to help bridge a gap that I saw in services in Colorado Springs. The greatest gap I continued to see was that skills were not generalizing unless they were explicitly taught in those areas and under the conditions of a very controlled environment.
Prior to moving to Colorado, I was lucky enough to have started working with a fantastic large corporation when I first started in ABA in California. My supervisors were thoughtful and passionate about not only generalizing across people and settings, but by actually taking the steps to program for generalization (Stokes and Baer, 1977). I worked with clients in their homes, social skills groups in the community, and at school. I was privileged to be a part of that impactful change for some amazing families.
I felt it was my calling to bring those same practices to families in Colorado Springs. The services offered to families in this area are often outdated and stunted and not always individualized or with the client’s values and the family’s culture in mind. At Across Environments, we strive to do better.
We take that as a challenge for ourselves as an organization and as practitioners who carry a heavy weight of responsibility in helping improve the lives of others. We find that changing behavior has lasting effects when we focus less on the deficits and more on the strengths. Our clients are a part of their learning and behavior change process. In my experience, I have seen many companies use standardized assessments and programs that are incredibly limiting and very rarely meaningful for the family or client. These assessments and programs are usually geared and designed to help teach basic learning skills but that often results in reinforcing rote responding.
Across Environments builds upon the client’s current repertoire. We work with the client and the families in the areas where they would like to grow and learn more as well as areas where they may need additional support to manage behaviors that may be determined as problematic. When we address problematic or barrier behaviors, we focus on what the client wants. We ask them questions when we can, and we observe to see how these behaviors have been shaped and how they can be systematically changed for the better, if they need to be changed. We find that many behaviors are a part of the client, and as long as they do not interfere with the client’s ability to access a meaningful life, we do not try to change those behaviors such as stemming or other automatically maintained behaviors. We work with clients with ADD/ADHD, autism, PTSD, RAD, depression, anxiety and other diagnoses; however, we determine how best to help based on what the need is and not the diagnosis or label.
Although we do intervene by using function-based interventions, we also understand that the four functions of behavior (tangible, attention, escape, and automatic) only account for environmental stimuli and not intrinsic yearnings. We program using not only the function that can be manipulated by outside stimuli (Giving a toy, praising, removing a demand or an aversive stimulus, providing tools to address automatically maintained behaviors), but also for the client’s core yearning (belonging, coherence, feeling, orientation, chosen purpose, and competence) – that underlying and internal longing or need that our helps feed our minds and inner wellbeing.
We teach with the understanding that there is no “one-size fits all or most” situation when it comes to individuals. Our clients are assessed with many different measurement tools and functional and skills-based assessments such as the BRIEF-2, SRS-2, VB-MAPP for our learners who are under the age of 4 years-old, the PEAK curriculum that is founded in Relational Frame Theory, Acceptance and Commitment Therapy to help teach psychological flexibility, as well as programs that target a specific need. Our approach is always Trauma-Informed and free from coercion or withholding needs contingent on responding. We take parts of some assessments and some of that curriculum and then determine programming that is focused and holistic, but most importantly, a program that is specific to that client and that client only. Changes to programming do not happen without the client and the family’s input.
We work with the full team (Speech Therapists, Occupational Therapists, Physical Therapists, Music Therapies, Family Therapists, and other providers) and feel passionately about supporting other service providers. We honor flexible scheduling and we schedule in accordance with what the client needs as opposed to simply maximizing the payout from insurance with the maximum hours allowed. We have fun with our clients and our clients’ families, and we love working as a team!