Occupational Therapists Discussing Their Journeys with ABA: Part 2

Interview conducted by David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment

Interviewees:
Tanya Browne, OT Reg NB, BCBA
Kristina Gasiewski, MEd, MOTR/L, BCBA
Angela L. Seal, MOT, OTR
Amy Stango, OTD, OTR, BCBA

Part I of this interview can be found here.

David: In last month’s interview, we discussed your very interesting and unique career paths and how they intersected with applied behavior analysis (ABA). We also discussed some of the many misconceptions that can serve as a barrier to respectful dialogue and effective collaboration. I am very excited for each of you to share your thoughts on how we can address this.

What suggestions do you have for occupational therapists to either better learn from or support behavior analysts?

Kristina Gasiewski, MEd, MOTR/L, BCBA

Kristina: I think it all starts with practicing open communication. This is how mutual respect and trust can be formed. Having professional dialogue addressing why interventions are being recommended by both the OT and BCBA is an effective way to learn from each other. Also, participating in continuing education and journal clubs can be helpful as there are overlapping scopes of practice.

Angela: The first suggestion is to come with an open attitude, ready to fully collaborate on a plan to address the client’s needs. Be willing to assist in creating interventions (e.g., task analyses) with the behavior analyst and identify what steps may be the most challenging for the client based on the underlying deficits that you have identified through the OT evaluation. Then based on this, offer treatment suggestions to address those deficits. Bringing research or data to support your concerns or your recommendations strengthens any suggestions you make during your discussions.

David: What suggestions do you have for behavior analysts to either better learn from or support occupational therapists? What would you like behavior analysts to know about occupational therapy?

Amy Stango, OTD, OTR, BCBA

Amy: I think that behavior analysts need to understand how much they have in common with occupational therapists. Both occupational therapists and behavior analysts are highly trained professionals. While there are some philosophical differences between the two fields, both occupational therapists and behavior analysts share values such as beneficence, veracity, and autonomy.

By working together, occupational therapy and behavior analysis professionals can produce better client outcomes. Using common terminology, rather than jargon unique to one’s field, can support better interprofessional communication. Taking the time to learn more about each field may also lead to a better understanding. The ASAT website has many resources regarding behavior analysis that may be helpful to occupational therapists. Behavior analysts might find it helpful to read the fourth edition of the American Occupational Therapy Association’s Occupational Therapy Practice to gain a better understanding of the field and its terminology.

Tanya Browne, OT Reg NB, BCBA

Tanya: When considering what I would like behaviour analysts to know about occupational therapy, I am brought back to the numerous “I didn’t know OTs did that” statements heard throughout my clinical work and throughout my BCBA supervision. First and foremost, OTs are healthcare professionals who do more than provide sensory strategies and tools to clients. The OT considers a person in their entirety, including their physical, cognitive, and affective well-being, and how challenges in these performance areas can impact the daily activities and commitments which are important to that person. This perspective is founded on their knowledge of anatomy, physiology, pharmacology, neuroscience, mental health, inclusion, social influences, interprofessional health, health conditions, and professional practice, which also inform their individualized assessment and intervention plans. Second, the cornerstone of OT practice is the use of activities that are important and meaningful to an individual (occupations) within intervention/rehabilitation to enable skill development. To do this effectively, courses aimed at building competence in task analysis, as well as shaping and chaining, are included in their formal training, thus OTs have knowledge of behaviour change procedures that would overlap with the practice of a BCBA. Third, OTs pride themselves on their client-centered interviewing skills and sound observation skills which have been developed throughout their formal training to ensure valid, accurate, and reliable reporting in practice, which I hope will allow BCBAs to trust and accept the information being shared with them by other team members.

Angela L. Seal, MOT, OTR

Angela: As was suggested in my answer above, my first recommendation for behavior analysts is to come with an open attitude ready to fully collaborate on a plan to address client deficits. It is important to understand that OTs do not necessarily work from the same theory base that BCBAs work from when assessing and planning for clients. OTs have been trained in a wide range of areas to allow assessment of underlying deficits whether it be developmental, anatomical, physiological, neurological, or sensory. It is important to note that because OTs have learned different terminology from their training, many times, they will often explain behaviour and the purpose of the behavior differently than the BCBA. Many times, OTs and BCBAs are discussing the same thing but there is a disconnect in the expression of the ideas due to the different terminology. It is important to be patient and continually work toward operational definitions within a collaborative treatment plan.

David: In your experiences, what are the key factors related to successful collaboration? How do you promote collaboration? How do you handle situations where collaboration isn’t present?

Angela: A key factor includes communication, but more specifically within communication is listening, patience, and perseverance. A willingness to be patient, listen, and restate what is being heard is a good start to establishing a good rapport and working relationship between each professional. However, perseverance is key in that both professionals need to continually work to understand each other’s position and goals related to a client. When collaboration is not present, unfortunately, the outcomes are just not as strong. The practitioner needs to continue to keep open communication as much as possible, but in the end, a practitioner can only work within the framework in which he or she is skilled and provide the best possible service he or she can. The most important part of this is to be sure that communication to and about the other practitioner(s) is always professional and not derogatory in any way.

Tanya: When I think of collaboration in practice, I think of a group of individuals coming together to share information and jointly contribute to an intervention plan for their common client, drawing from their own experience and knowledge. To be successful within this collaboration, it is pivotal that the client is the focus of the conversation; the client is why the collaboration is occurring and the team must not lose sight of that. Achieving this client-first conversation can sometimes require attendees to be reminded of the purpose of the meeting, and by each clinician sharing ideas and asking questions with this common purpose in mind. Furthermore, I believe it to be important that individuals not only be cognizant of their own scope of practice but also familiar with the skills and competencies of other clinicians so that everyone is encouraged to contribute optimally to the conversation. In our model, collaboration with other professionals occurs multiple times per day, and this experience permits us to lead by example and often take a leadership role within stakeholder meetings given our perspective on the value of such an opportunity.

Kristina: Having open communication is imperative to successful collaboration. This goes hand in hand with open mindedness! Each discipline comes to the table with different approaches based on their own professional training within their own field. Being able to realize this as an asset, is so important. While a professional may not initially agree with a treatment approach, having an open mind to engage in a respectful and professional dialogue will go a long way. Research is ever growing and combining each profession’s knowledge and skill sets is really what will be most beneficial to our clients.

I am fortunate to work in an environment that has systems in place to facilitate better collaboration, such as scheduled team meetings on a regular basis. Even with time built in, however, there has been times where collaboration did not occur. I think it is important not to take it personally. If there was a breakdown in collaboration, oftentimes it’s due to miscommunication or unintentional oversight. Having a respectful conversation on what you would have suggested if you had been given the opportunity to collaborate, and how best you can support the team moving forward has helped me with developing stronger professional relationships. This in turn prompts better collaboration in the future.

David: What are your hopes for the future with respect to occupational therapist-behavior analyst collaboration?

Kristina: For each profession to see what the other can bring to the table. My hope is for both OTs and BCBAs to recognize that while we are two different professionals with different philosophical viewpoints, each profession can provide a unique valued skill set to achieve a common goal. Working as a team is an asset but will only be beneficial if there is mutual respect. Open communication as well as practicing within your own scope of competence is crucial for a collaborative system to work.

Angela: My hope is that there is more respectful collaboration between occupational therapy and behavior analysis with an understanding that both professions continue to grow and change related to research, past failures, and past successes. Through this, I would hope that discussions about differences and similarities between the professions would lead to strengthening the other profession as occupational therapy and behavior analysis fit so well together in filling the gaps the other profession may exhibit.

Tanya: When the beliefs and values of each profession are examined, the overlaps between the two professions are noteworthy from an applied, behavioural, and generalization perspective. It is not until one further evaluates the components of training and experience requirements of occupational therapists and behaviour analysts for certification that the differences in clinical competencies are more distinct. In my opinion, it is these similarities and differences which make the professions of OT and BCBA complementary in practice, with both focused on the quality of life of the client at their core.

My hopes for the occupational therapist-behaviour analyst collaboration are that the conversation about the importance of such a relationship occurs more frequently, openly, and honestly, and that both disciplines demonstrate their interest in learning from each other. We must remember that environments can shape our behaviour, and thus it is imperative that we create situations that are safe and supportive so that both equally important disciplines are motivated to move forward in collaboration and reinforced for their efforts.

Thank you all again for participating in this second interview. We are very grateful that you were able to share your experiences and hope that your perspectives and insights will be considered by others. It is essential that a strong multi-disciplinary team relies on scientific advances, uses the scientific method to conceptualize intervention efforts, and is grounded and guided by data.

Reference:

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2) https://doi.org/10.5014/ajot.2020.74S2001

Citation for this article:

Celiberti, D., Browne, T., Gasiewski, K., Seal, A., & Stango, A. (2022). Occupational therapists discussing their journeys with ABA: Part II. Science in Autism Treatment, 19(12).

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#BehaviorAnalysts #OTs #Multidisciplinary #Centerbased

Occupational Therapists Discussing Their Journeys with ABA: Part II