Ep.17: Compassionate Care ABA in School

This week we explore "compassionate care ABA" and how it works in schools. ❤️ Learn practical strategies to build rapport 🙌, understand triggers 💡, and empower student success 🌱 – all while fostering a positive classroom environment.

Compassionate care isn't just about being "nice," it's about applying the science of behavior analysis ethically and effectively. Compassionate care represents a positive evolution within the field of ABA (not replacing it). It emphasizes the learner's voice, choice within therapy, and respect for the individual throughout the behavior change process.

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Transcript

Audra Jensen: that empowerment to make those choices, That fosters autonomy and that is compassionate care. So whenever there can be a choice and whenever they can have a voice in the decision making I think we need to empower them to do that

Welcome to the Misfit Behaviorists Podcast. Join your hosts, Audra Jensen and Caitlin Beltran, here to bring you evidence based strategies with a student centered focus. Let's get started. 

Caitlin Beltran: Hey, everybody. Welcome back to the Misfit Behaviorist podcast. Before we dive in, just a quick reminder to follow us on Instagram at the Misfit Behaviorist podcast. Also join our Facebook group, same name, Misfit Behaviorist. And in the Facebook group, we try to drop some freebies that align with each week's topic. So we'll give you a heads up on that in our socials. But Audra, I'm going to turn it over to you. What are we talking about this week? 

Audra Jensen: So I was thinking last week about the evolution of ABA over the years that I've been involved in it and how it's changed and morphed and improved. And I wanted to talk about what I would like to call compassionate care ABA. It's kind of the transition of ABA in kind of the old kind of hard nose. You're going to do something ABA into more of the research base but still much more responsive to our students and our learners and a compassionate vein of ABA and how it still works really well together.

And so, I want to talk about compassionate care ABA and how that is bringing forth the client dignity and collaboration and all of that still promotes behavior change and a supportive positive learning environment. So that's what I want to talk about today. What do you think? 

Caitlin Beltran: I love that so much, and I feel like it is just as important, if not more so, than all of the technical aspects of ABA, so I love that we're going to dive into this topic.

Audra Jensen: Right. And so, compassionate care kind of translates into our ABA, or everyday practices, with some key strategies that I was thinking about. So, I thought of four different ways that we can promote compassionate care in ABA. And the first one I thought about to create this kind of positive learning experience was to build learner rapport and I think about early ABA when I was doing like 25 years ago when my son was little, it was very much about these are the expectations. These are the rules. In fact, we did a lot of, these are the rules and you follow the rules. And there wasn't a lot of teaching of understanding and where he was in the process and where his understanding was.

 He didn't come with a lot of trauma. And a lot of the kids that we have today do come with a lot of trauma. And I think it's really important that We figure out how to deal with that as well. And that comes a lot with building that learner rapport. And so I've dealt with a lot of staff over the years and taught them.

Look, the number one thing for you is for you to become the reinforcer. The most important thing for you to do is to become the thing that the child wants to be with. So in the beginning, all you're going to be doing is pairing yourself with whatever it is that they're interested in. And don't worry about the goals.

Don't worry about the data. In the very beginning, you're just building yourself as the reinforcer. So, So if they're interested in playing with a piece of string, get down there and play with the piece of string. It's totally fine. And so you're building that rapport with them. So you're emphasizing that positive reinforcement.

You're building trust because a lot of our students come in with, they have a lot of trust issues. And so you want to build that positive trust, understanding their preferences, beef up that positive reinforcement opportunities, catch them being awesome. So that's the first thing I think really building that rapport from the beginning.

Caitlin Beltran: Yeah, for sure. And I think, like you mentioned, we all learned how to pair with our learners, whether we learned in practice or in textbook, but I do feel like somewhere along the way, sometimes that has a bad rap nowadays, where it's oh you're just pairing with them so that you can turn around and make them do something or something like that.

And I don't know when that just became such a negative connotation. If you're taking a child to a counselor, the first couple of sessions, that counselor is just going to get to know the child. They're not going to hit them with some heavy probing questions about why they're there. So I don't see why it's so different and seen as a bad thing in ABA because like you said, our whole goal is just to get this child to like us, just to get them comfortable with us and near us.

And that means so many different things for so many different learners. I have a learner that I could sit and talk about Minecraft with for the first hour I meet them, or I have a learner that I'm thinking of a little girl who came to us so behind in so many ways, she had never been to school. She had never left her house much.

She's nonverbal autistic child. And I spent the whole first two hours just following her around and like dropping like little gummies next to her because she wouldn't even take them from me, her favorite food. I was just showing her like I don't want anything from you. I just want to show you good things.

And so, hours and days and weeks later, this child was able to look at me and, indicate that she wanted something and maybe do something that was appropriate. Put her coat on to go outside or something first. And I also wanted to mention, I think this gets overlooked in the second stage once we've built the relationship.

Sorry, I'm doing a lot of talking at once here. Do it. I think sometimes this gets overlooked when we move from the pairing phase. Once the child has accepted us and once the child likes us, we're seen as an agent of reinforcement. We don't have to stop building that relationship. And I don't think many people do this on purpose, but sometimes it's okay, they're up to, five tokens and 10 demands each.

But I'm always a huge advocate of like, right, that's great. And every once in a while, just give them a freebie. And people look at you like, I don't know, they're up to five tokens and 10 demands each. And it's right. And every once in a while, give them a freebie because in real life, that's what you get.

And you still want them to remember on their worst day this person is still someone who sometimes gives me something just for showing up just for nothing. 

Audra Jensen: That's exactly what I was going to point out is that you don't just build rapport in the beginning is that you need to continue that throughout the time and you're going to infuse yourself as that positive person in their life throughout everything.

 And you may find that a learner you build that rapport and they start developing skills and stuff and then all of a sudden there's pushback and stuff. Then take everything away again, take all the data away, put all the skill sets away and go back to the floor and engage with them and build that rapport again, because maybe something's happening in their life that you don't know about.

 Maybe they've hit a wall in the learning or whatever. Maybe they just need a break. I mean, don't we all just need a break sometimes? Yeah,

Caitlin Beltran: Meet them where they are every single day that where they are yesterday or this morning, meet them where they are right now. 

Audra Jensen: I learned a lot of this from a number of years ago back when I'm going way back when I got my BCBA was 2007 and it was up in University of Washington, and I did my student teaching under a fantastic gal that was doing I think it was a birth to three if I remember it so many years ago I can't remember she was doing a birth to three. It was an autism program, but she came from a floor time background. And so she wasn't a BCBA the behavioral background But she was the floor time and I came in with this BCBA behavior background.

We worked really well together. And a few years later, when I had opened up my ABA clinic and she moved down to where I was living, she contacted me and I brought her in and she actually ended up getting her BCBA, but she had that floor time background. And so I learned so much from her about that ability, that need to connect with a child down on the floor.

I mean, getting that pivotal response, that connection is just so important. So that's that was the number one thing. I think I thought about as I thought about compassionate care, because I think it's the most important thing as we go through with these other ones that just building that rapport, not only in the beginning, but throughout the whole process.

And so the number two thing I think about builds from that is looking at antecedent based interventions. Everything that you can do beforehand, so focusing on triggers and setting events and everything that you can do proactively that prevent the behaviors from actually happening, because what you're doing, then you're teaching those replacement behaviors, you're preventing the challenging behavior, you're building that positive experience at school and at home, having those social feelings social experiences, feelings of safety and inclusion while being at school, all of that stuff is going to promote that feeling of trust and safety that the child needs as well. 

Caitlin Beltran: Absolutely, and I think one of my favorite strategies to build into any behavior plan is that antecedent strategy of non contingent reinforcement. Which I guess technically is a reinforcement based strategy, but we're using it antecedentally. This isn't a technical episode. 

Audra Jensen: No, it's not. 

Caitlin Beltran: They 

Audra Jensen: It never will be. 

Caitlin Beltran: They never will be. So just even whether you're setting that timer every 5 minutes, every 25 minutes on a variable interval of 10 minutes.

Making sure you're catching them being good, like you said, and timers are our friends, because otherwise we forget, and then we're getting the skill data, and we're like, yeah, no, I'm always giving them freebies, I'm always catching them being good, but It that timer is going to make us accountable for that strategy the way that another strategy is going to be accountable for. Like you're definitely going to give the token because the tokens right in front of you or you're definitely going to flip the card because the card is tangible, but the praise and the intangible things like that should be linked, I think, always to some kind of visual or timer for us, not necessarily for the student. And literally, whatever, if you're lucky enough to have found the function or one of them already, if it's attention, if it's inedible, if it's something like, put that on the time schedule and they don't have to do anything for it.

And you can increase it, of course, because as the learner gains skills, you want to emulate the real world, but keep that in, even if it's like a really infrequent schedule. 

Audra Jensen: Right. I love that. And I love the whole idea of just looking at your environment and everything that you can do to prevent those behaviors from happening.

 It's so much easier to prevent a behavior and create a positive learning environment than it is to What is the old phrase? It's easier to ask for forgiveness than permission. It's easier to prevent a behavior than to try to undo a behavior that's happened. And so I think the better we are at preventing those behaviors and putting those supports in place preventatively is compassionate care.

I mean, it really is. We don't want them to have those negative. I mean, nobody wants to be in crisis. Nobody likes those feelings. We've all been in crisis when students are in crisis. Those are horrible feelings. So we don't want that for ourselves. And we know that these little tiny humans don't want that either. And so that's why those concepts are really important. 

Caitlin Beltran: I'm thinking of that one episode where you showed us that kind of scale or like that mountain, the behavior mountain and at the peak, right? And if you can avoid getting to that peak, even if you can avoid like out of 10, if they're getting to an eight or a seven or a six instead of a nine or 10, that's so huge.

And that way to do that sometimes is just putting that non contingent reinforcement. What are they looking for? If it's attention, flood them with attention. If it's tangibles, flood them with tangibles. Make it so that by the time they're like about to do that old behavior that gets them that thing, they're like, meh, I know it's coming soon anyway.

Make it irrelevant. Make it inefficient. Make it just so much easier to be flooded with the things that they want that they're not even thinking of ways to engage in that problem behavior to get that. 

Audra Jensen: That also leads really well into number three, which I think is that giving them choice, skill acquisition and behavior management with choice.

So offer options providing students with that choice, not only in, do you want the red pencil or the blue pencil, but give them choice in goal setting. This isn't something we did 25 years ago, but as early as possible as they can be engaged in what they want to work on, what's important to them, giving them that empowerment to make those choices, That fosters autonomy and that is compassionate care. So whenever there can be a choice and whenever they can have a voice in the decision making I think we need to empower them to do that. As they get older and those kind of those their ability to make those choices and to stand up for themselves in certain situations as our world is crazy I think that's really important to give them that power And gives them that confidence to do so. So that was number three. I thought about is giving them choice. 

Caitlin Beltran: I just love, love, love providing choice as an intervention. And again, I think it's something that gets a little overlooked because it's like easy to think yeah, I do that sometimes. I ask them if they want to sit in the side or if they want to sit with me.

But like you said, just like peppering it into so many different aspects, even just like making a visual for your staff or yourself, list 25 choices you can offer that day and literally think about them beforehand. So seat, pencil, task, which staff to work with, which, you know, whatever. And then, sometimes you get the pushback they can't choose everything, right? But if it's on their menu of 25 choices that day, then they can, right? Because it's a controlled choice. They're still listening to me. I'm just giving them some autonomy in the process and then start crossing them off. And then maybe the next day is like still 25 choices, but it's in different areas.

And maybe you're keeping the learner on their toes that way. And I always think of this workshop I went to like forever ago. And I think it was Peter Gerhart, but I'm not sure. But he talks about this study. I know of choices and as like a typical adult person, supposedly there's some sort of statistic or research that like you make whatever, 364, 000 choices in a day.

I mean, you could argue it's like infinite. Cause should you go to work? Should you get coffee? What kind of coffee? Exponential choices. And as a child, adolescent or adult with a severe disability, on average, they make like eight choices a day if they're lucky. Who, nobody's asking them all these things because it's get your shoes, get your coat, get your car.

I think of it of my own son, a typically developing seven year old. Like sometimes I'm like, oh yeah, do you want to wear this or that? Because like just trying to give him some choice. Of course he speaks up when it's something he really wants, but so much of his schedule is just dictated for him because he's a child.

So just putting yourself through that lens and thinking about it that way I think has always shifted how I thought about it going forward and how important that choice is. And you can find a choice anywhere in any situation. 

Audra Jensen: I love that so much. I don't think we realize how important that concept is. The fact that we make so many choices for ourselves and yet we pull so many choices away from students. Students and learners over, you know, and and we think they're kids, we need to make those choices for him. But as my son has gotten older, some of the stuff that he, he never wants to wear a coat and I always made him wear a coat.

And now I'm like, why don't you wear a coat? And he's cause I'm always hot. I was like when he was little, he couldn't. Okay well, if he wants to be cold, I didn't realize he was hot, but you know, little things like that. If the student doesn't want to wear a coat outside, they can be cold if they don't want to.

Just giving them that autonomy, that choice making, I think is really important. And then, thinking about those goal settings, have them involved in as soon as they can be making the decisions of what they're working on,In a clinical setting, we're able to do this more because we're working on kind of the whole child and in a home environment and goals throughout their whole lives.

I think they're able to have a lot more say in that, which I really love. But even school with IEP goals and stuff, if you have a student who can communicate and you're working on their IEP, why don't you sit them down and say, Hey, I was thinking about working on this with you this year. What do you think? I think it's great to do. Let them have some voice on that. 

Caitlin Beltran: Right. Absolutely. 100%. 

Audra Jensen: So the fourth thing I thought about was celebrating effort and growth over just mastery of goals.

And I've seen over the years, a lot of goals either get transferred to the next year, they haven't been making progress, or they're too lofty and we've passed these goals by. Really, we want to see effort and growth and the goal itself. We want to really manipulate so that the student is showing that progress.

I mean, the goal is just, something on a page. It represents what the student is learning and I think we need to celebrate more of that effort and where they're coming from. And the celebration year over year of their changes, they're developing differently. Some years they're going to master a lot more goals than other years.

 And so just watching that we're not just focused on a goal on a paper, but we're really looking at that learner and the progress that they're making and the effort that they're making. Where they are in their life, and maybe they're going through a really, maybe mom died, something like that.

And so their effort is going to be, they're going to struggle more that year, whatever it is. So just really celebrating that effort and growth over the year and celebrating that stuff in front of other students, their effort, their growth, whatever in front of the students. 

Caitlin Beltran: I love that. We started doing in one of my classrooms this year, like sending certificates home as they acquire like a set number of words or numbers.

And I guess technically that is a skill. So we're rewarding both effort and the progress here, but you get the idea. And so actually just printing out a little certificate Oh, so and so mastered her next 10 sight words or something, because I think sometimes we get caught up in like the adult side of it, like the IEP, like we, can check off another goal. And we'll talk about this with mom and dad at the meeting. But literally just like having this child like take that certificate home, even though they might not fully understand it depending on your learner, like something at home now is celebrated for them. Whereas maybe their brother or sister is star student or gets to do show and tell all the time.

Something for them that gets a conversation piece at the dinner table look how, look what so and so learned, look how good so and so's doing with addition or sight words. And it's like a tangible piece to it where for a child who might not be talking about that, or who might not be recognized on the loudspeaker as much, or something like that.

Audra Jensen: You can also, I love the idea of certificates. I've done that over the years, and make them not just skill based, but effort based. You know, I was a really kind person today, or I put forth my best effort at this today, you know, and making it growth mindset stuff. I've also, I've had hanging up around the room sets of stickers and the stickers have something that say on them like I was kind, I did my best and stuff. We'd just rip them off. Wow, you did such a good job right there. And then, they're wearing it right there in front of their little friends. And it's I got a sticker today. And I don't know why kids like stickers, but they love stickers. 

Caitlin Beltran: Every kid goes through the sticker phase. 

Audra Jensen: So, those were my kind of four thoughts about compassionate care.

And compassionate care isn't just about being nice. It's really about applying the science of behavior analysis ethically and effectively. So compassionate care represents that positive evolution over the course of the years that I've seen it happening. It doesn't replace ABA. ABA still has some of the most robust research to promote student progress on goals improvement on cognitive skills integration into social interactions in society, you know, so, it really is just our shift of how are we doing it in such a way to really be responsive to our students, our learners, and where they are.

Plus, it's so much more fun to have, to build this sort of rapport with our students. And it's okay to put the data aside and the goals aside and to get down and just roll around with your kids. Because, who doesn't want to be a five year old every couple of days? 

Caitlin Beltran: And I'm glad you said it that way.

We're not trading one for the other, right? We're still doing ABA, and sometimes that gets fuzzy. Like, ABA, bad. Compassion, good. Like,I'm practicing very, researched, evidence based ABA every day, but as you mentioned, trying to learn how to become more trauma informed and more compassionate care focused so that I'm infusing it into my ABA practices and it's just that my ABA practices are hopefully becoming more compassionate and more treating, everybody around with dignity and respect a little bit more each the more that I learn and grow, but I'm not throwing anything out the window.

I'm just You know, taking what I have and hopefully making it better, hopefully making it even more productive and more efficient, 

Audra Jensen: I can see the results of that as I've seen so many kids from very little, over the 20 years, and I've tried to really practice compassionate care over the years without knowing that's what I was doing. But I mean, like my son He's autistic, but he is the nicest guy. I mean, he really is a nice person and I'm looking at all the other kind of, they're now adults and they're just really nice people. And I think that's partly because we were really responsive to who they were.

And it was really important that we weren't just getting the skills down, that we were really getting that environment of rapport and building a relationship. I still have old clients who are now adults that are Facebook messaging me and stuff and tell me about their jobs and stuff. It's really cool.

So yeah, compassionate care. It builds with ABA. ABA is really that science of behavior, but it works compassionately, and that's what we want for all of our peoples. So yeah, that's what I want to talk about today. 

Caitlin Beltran: And I just wanted to add, we didn't talk too much about in the heat of the moment, like during a behavior episode, sometimes that is when it's most important.

Yes, we're following the plan. We're doing all the things we're trying not to reinforce the behavior too much. But I think there comes a fine line between reinforcing the behavior. No, that's not what I'm doing. But I'm responding to the behavior with compassion. That old school just ignore, turn your back is out the window.

And for a long time, I was saying ignore the behavior but not the person. But everyone would say, okay, so I ignored it. I ignored it. And I'm like, okay, if it's so misperceived, why am I still using this word? I'm just going to not use trying to use the word ignore. I'm just going to say, don't give that verbal attention.

Maybe that's what I say instead. Instead, I can give the child verbal attention and say, I see you're having a rough time. Your choices are this and this. Lower my voice. Speak with them. Just all those things that hopefully we've been doing the whole time, but just becoming more attuned to. And I feel like since I've really made a conscious effort to push that even harder and really make that my primary approach, I can see my relationships with these kids getting better and I can see them becoming more trustful of me quicker.

Audra Jensen: I think that's also remembering afterwards, after a crisis to go back to the child, to make sure you're building that relationship afterwards, repairing that because when you're in a crisis and sometimes we are in really difficult situations and we are in crisis as well and it damages the relationship to make sure after the crisis is over and after some time has passed, you go and you rebuild that. You put your arm back around you play with the string again, whatever it is to build that relationship back together. 

Caitlin Beltran: Right, especially if you're dealing with a kid who it's like you're moment to moment that's in the past, you know. They did probably didn't get to go outside.

They probably didn't get the reward. That's All well and good. I'm not saying they should rainbows and throw cupcakes at them, but right. They're still a human being and I can still certain to them and be like, so what do you got planned this weekend? Or if they can't have a conversation, just look at them.

Oh, that was scary for a minute. It got very loud. I'm glad it's quiet. Can I get some water? Like just anything, like just a conversation, just you seeing them as a human being. 

Audra Jensen: And validating what they're feeling, what they're saying. I mean, many times I put my arm around somebody, Hey, you were feeling really scared a minute ago, weren't you?

You were feeling really angry. I could feel your anger, you know, and just labeling that because, they have these big emotions, they may not be able to label or understand where they're coming from or what they are. And so I think it's really important that we do that. 

Caitlin Beltran: I started to say in my follow up now, instead of just saying this was all good.

Let, next time, let's try this. I'm like, wow. Just like you said, I'll start by saying I noticed you were like really upset and I just want to make sure what can I do better next time? Was I too close? Was I too far next time? Do you want me to turn around? And I've had a couple of kids are look at you like, huh?

But after a while they'll, and they'll say something and you know what? Maybe they'll say, Oh, you just had to raise your hand and next time I do that and it didn't necessarily work. But I think that we're getting to the in the right direction sometimes where, I'm not, the point is, it's not foolproof.

But I think it's still giving them a voice and it's still teaching them that, okay, but if you decide to give me the answer that does work in the moment next time, I'm going to listen. I'm going to do it. 

Audra Jensen: Yeah, I really like that. I'm going to use that. Cool. That's all I have for today's episode. 

Caitlin Beltran: All right, awesome.

So I love that we talked about compassionate care. I think we touched on just four, large overviews but definitely hit us up on Instagram and the Facebook group and let us know what you think and how you guys are practicing this in your routines. Next week we are going to talk about some more specific like back to basics, behavior 101, strategies to just pull out when it seems like nothing else is working.

So join us then and we'll see you next week. 

Alright, see you then. 

Thanks for listening to the Misfit Behaviorists. And be sure to tune in next week for more tips and tricks. Don't forget to subscribe so you don't miss an episode.