An Interview with Dr. Lina Slim

Conducted by Adriane Miliotis, MA, BCBA, LBA, and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment

Dr. Lina Slim

Dr. Lina Slim, Ph.D., BCBA-D, CCC-SLP, is a Certified and Licensed Speech-Language Pathologist and Board-Certified Behavior Analyst – Doctoral, with over 30 years of experience specializing in the diagnosis and management of children with Apraxia, neurodevelopmental and behavioral disorders, and Autism, with a focus on Interprofessional Education and Collaborative Practice. Dr. Slim is recognized for her innovative “Authentic Interprofessional Culturally Aware and Responsive Collaborative” (AICARe-Collaboration) approach and has authored numerous articles and chapters on the topic. Among her accomplishments in the past year, she’s published an article titled “A Behavior-Analytic Perspective on Interprofessional Collaboration” in Behavior Analysis in Practice (Slim & Reuter-Yuill, 2021) as well as a book chapter titled “Culturally Aware Practice: Cultural Considerations for Delivering Effective Treatment” (Slim & Celiberti, 2022) in A Scientific Framework for Compassion and Social Justice: Lessons from Applied Behaviour Analysis (Sadavoy & Zube, 2022). Recently, we had the pleasure of sitting down with Dr. Slim to discuss her thoughts on growing up in a multicultural household, collaborating across professions, and working with culturally and linguistically diverse families.

Adriane and David: Thank you so much for taking the time to answer our questions and share your unique perspectives with our readers, many of whom will immediately notice your diverse credentials. How did you initially get involved in autism treatment?

Lina: There were multiple events that pulled me into autism treatment. These experiences started in my elementary school years back in the 1970s. I struck-up a friendship with a classmate who appeared and behaved differently. I was curious and impressed with the unique ways she saw the world around her and the different manners in which she communicated about things and responded to people and events. At the time, I was sad and upset that people refused to include her in their circle of friends. This ignited my drive to help get her voice heard and have people see how witty, smart, and funny she was and appreciate her gifts.

Years later, in my master’s program in Communication Science Disorders, I was exposed to different externships as part of my clinical practicum fieldwork experiences. Through these externships, I interacted with several young individuals who, at the time, were labeled as autistic. I was particularly drawn to the beauty and intelligence inside that I felt no one else saw. Reigniting that same passion I had felt years prior in elementary school, I was again driven to make sure that their voices were heard, recognized, accepted, and that their wants were met.

However, as a student, I quickly became frustrated and saddened by the lack of resources and direction I was given in order to have meaningful and productive communication with the children with whom I felt such a desire to connect. Eventually, I was assigned to do a clinical observation practicum at an autism clinic. For the first time, I saw an approach where the students appeared to be engaged in fun and reinforcing ways. I immediately knew that I wanted to learn more about this approach and more specifically about why and what led the children to engage and communicate with others in the manner they did. During and after my graduate studies in speech-language pathology, I continued to seek more information about autism by attending lectures and presentations on the topic given by both certified speech-language pathologists as well as behavior analysts.

When I started my professional career working as a speech language pathologist in the schools, I noticed that children with learning and developmental differences were receiving disparate treatment that was not consistently individualized and science-based. As I worked with more children specifically on the autism spectrum, I realized the disparity was greater than even I had originally thought. They lacked access to evidence-based instructional practices and were subject to ineffective treatment. I was disheartened and could not stay silent! I just had to do something to change the way people on the autism spectrum were viewed and helped and to ensure that their rights were protected and upheld!

Adriane and David: What an incredible journey starting with your passion for connecting with your classmate back in elementary school. You come from a diverse background yourself, both professionally and personally. How have your own experiences being raised in a multicultural household and later as a dual-certified professional influenced your work with culturally diverse families?

Lina: We are all the outcome of our learning histories and circumstances, and our behaviors are influenced and shaped by our experiences and our verbal communities. I grew up in Beirut, Lebanon, a country known for its religious, ethnic, and linguistic diversity. I was raised multi-lingual (i.e., Arabic, French, and English), with English being the third language that was introduced in middle school. Being exposed to people who think, act, and communicate differently has allowed me to appreciate differences in responses, beliefs, and values. These diverse experiences have conditioned me to be a better active listener in order to navigate unpredictable and varied social landscapes. I learned adaptive and flexible problem-solving skills and culturally responsive negotiation skills. These skills have helped me address conflicts or challenges in creative and compassionate ways while achieving my own personal goals within a mutually agreeable manner. Throughout my upbringing, negotiating and collaborating were a constant means of navigating my environment for survival and success, so it’s fitting that I’ve chosen to focus on collaboration in my professional career.

Similarly, my professional background blended different educational disciplines. My undergraduate studies were in pre-medical studies with a major in biology and a focus on animal behavior and psychology. My master’s studies were in communication science disorders. My doctoral studies were in leadership and interprofessional health sciences with a focus on applied behavior analysis, autism, and instructional practices. And finally, my postgraduate studies were in behavior analysis. Throughout my education, I learned critical skills needed to effectively collaborate towards a shared outcome. My educational experiential learnings provided me with countless training hours in which I interacted with students and professionals who had different theoretical backgrounds and used language specific to their individual disciplines. I engaged in team activities and practiced using interpersonal skills to achieve a common goal. Because of my experiences growing up, I was able to respect different opinions and incorporate diverse evidence-based approaches. Learning from, with, and about each other, otherwise known as interprofessional education (IPE), was at the heart of my educational and personal growth experiences, which enriched my personal relationships, enhanced my professional growth, and shaped my practice.

My learning history and experiences have certainly shaped and strengthened my practices to embrace interprofessional collaboration. As I continue my journey of serving others and interacting and engaging in conversations with people who think differently and come from different cultural and linguistic backgrounds, I am humbled, grateful, and fulfilled in every way! As a dually certified speech-language pathologist and behavior analyst, I find myself applying culturally responsive interpersonal, communication, and collaboration skills in all aspects of my life. Using these skills helps me to build trusting relationships and partnerships that will guide me in my learning to be a more compassionate human and to better serve others. Furthermore, I strive to ensure that my practice is informed, person-centered, and culturally responsive.

Adriane and David: You have written and presented numerous times on the topic of interprofessional collaboration. This is such an important topic for both seasoned professionals and those that are new to the field. Can you take a moment to share some insights on both collaboration in general as well as specific responses that underlie collaborative behavior?

Lina: As humans, we are all the products of our unique learning histories. These histories shape our perceptions, assumptions, beliefs, values, and biases. As such, when we work with others, we are undoubtedly going to encounter people who think and behave differently. Being aware of the influence that our biases may have on others’ responses can improve the quality of our conversations and relationships. If our goal is to establish respectful, strong, and trusting partnerships to enhance the quality of health outcomes of those we serve, then we need to engage in what I call “Authentic Interprofessional Culturally Aware and Responsive Collaborative Practice” (AICARe-Collaborative Practice).

AICARe-Collaborative Practice consists of four domains:

1. Cultural Sensitivity and Responsiveness – Cultural Sensitivity and Responsiveness is defined as being able to adapt and deliver meaningful and appropriate support and consequences. It means attending mindfully by being an active listener; self-reflecting by engaging in self-observation and self-description regarding our overt and covert behavior (Fong et al., 2016); and being aware of our personal biases, beliefs, thoughts and feelings and their impact on our practices and relationships (Slim & Reuter-Yuill, 2021).
2. Cultural Competence – Cultural Competence is defined as building a repertoire of behaviors that promote increased awareness of self and others (Brodhead & Higbee, 2012; & Fong & Tanaka, 2013); it assumes an end goal and a mastery criterion (Slim & Reuter-Yuill, 2021); relying on data, not emotional responses; and engaging in objective interpretation and analysis.
3. Cultural Humility – Cultural Humility is defined as “a virtue or disposition … that involves having an interpersonal stance that is other-oriented in relation to another individual’s cultural background and experience” (Hook et al., 2013, p. 9). It is acknowledging lack of superiority, our own limitations, and working to overcome them by seeking to understand and build the respect for others’ cultures.
4. Cultural Reciprocity – Cultural Reciprocity is defined as being open to reciprocal learning opportunities. It is humility in action. It means self-reflecting on embedded values and assumptions; engaging in active listening to be better informed; validating by respecting differences in assumptions and explaining the basis of your own; and collaborating and compromising to establish common goals and directions (Kalyanpur & Harry, 2012; Slim & Reuter-Yuill, 2021; Spencer, 2020).

We still have a great deal of learning, education, and training to do in order to acquire these collaborative culturally responsive competency skills. As behavior analysts and practitioners, we have a responsibility to improve our public image and ultimately uphold our practices to benefit society in meaningful and scalable ways. Compassionate care is at the heart of AICARe-Collaborative Practice.

Adriane and David: Recently, you co-authored an article on the topic of interprofessional collaboration (Slim & Reuter-Yuill, 2021). In this paper, you wrote about the Interprofessional Education and Collaborative Framework (IPEC) and the need for behavior analysts to embrace interprofessionalism in their practices. Can you share with our readers a little bit about IPEC and the core competencies? How can this framework help behavior analysts enhance their team approach within their practices?

Lina: My amazing colleague, Lilith M. Reuter-Yuill, and I co-authored the paper you are referencing, and we had a blast working together on it! Inspired by the World Health Organization’s (WHO) framework and the work by the Institute of Medicine (IOM), the Interprofessional Education and Collaborative (IPEC) Framework was designed specifically for health care professional schools to use as a guide in their curricular development.

The IPEC Framework includes four Core Competencies for Interprofessional Collaborative Practice (IPEC, 2016; IPEC Expert Panel, 2011). First, it is important to understand the different models of collaboration in which practitioners may engage. These models span a continuum from static and independent to dynamic, interdependent, and interactive. Practitioners are usually most familiar with two most common models. The first is the multidisciplinary model. In this model, professionals from different disciplines usually work separately, solving problems from their own theoretical perspectives, then meet as a group to share their findings, drawing upon their specific knowledge and skill sets. This model does not necessarily involve joint decision-making in the planning process. Discipline-specific jargon may be used, which may create barriers to communication and information sharing as well as non-cohesive and disjointed outcomes. The second form of collaboration is the interdisciplinary model, which involves an interactive process. In this model, professionals from different disciplines engage in analysis towards a coordinated and coherent outcome. However, this model requires practitioners to have a strong repertoire of interpersonal skills to facilitate interactions and navigate the challenges they may encounter when faced with opposing recommendations, perceptions of infringement, and frustrations. The model we propose in our paper for practitioners to consider in their inter-disciplinary practices refers to the interprofessional collaboration model, which requires both ethical behavior and interprofessionalism.

Interprofessionalism is a conceptual framework whereby practitioners engage in shared ethical practices and agreed-upon values, language, and communication that guide the ways in which they lead their inter- or multidisciplinary interprofessional team practice. The IPEC Framework is considered as an overarching “umbrella” that spans across other collaboration models since it provides a competency framework for practical adoption of interprofessionalism as part of a practitioner’s professional development. The IPEC competency framework includes four domains, each with several sub-competencies (IPEC Expert Panel, 2011; IPEC, 2016). The four domains cover team-based principles that guide practitioners in their collaborative and inclusive service delivery approach. Specifically, creating and maintaining a climate of mutual respect, shared ethical principles and values, ongoing clarification of roles and responsibilities, shared respectful and responsive language and communication, and shared application of relationship- and team-building values and principles. The sub-competencies within each domain provide behavioral guidelines to build the necessary repertoires of interpersonal skills and collaborative competencies that promote effective collaboration; enhance team-based practices; establish cultural responsiveness and professional humility and strengthen partnerships between professionals and families.

Behaving with interprofessionalism is well aligned with the foundational principles of the new BACB ethics code (BACB, 2020). Not only would we as practitioners experience personal and professional growth, but equally, the public image for our services would be highlighted as one that celebrates interprofessional collaboration, diversity, and inclusion, which will increase opportunities for impacting and benefiting the lives of those we serve.

Adriane and David: You recently co-authored a book chapter (Slim & Celiberti, 2022) discussing “Cultural Considerations for Delivering Effective Treatment”. Can you offer some suggestions for what we can do when working with families that come from culturally and linguistically diverse backgrounds?

Lina: Working on this book chapter with David was fun and filled with shared learning and insights! This chapter covers an important discussion to have! As I mentioned earlier, each of our unique backgrounds shapes the way we behave and interact with others. Therefore, there is no such thing as a “one size fits all” approach to working with culturally and linguistically diverse (CLD) families. Practitioners must consider “every family unit [and person] as being CLD” (Slim & Celiberti, 2022, p. 95). We must avoid overgeneralizing, stereotyping, or assuming that all members within a specified culture behave in the same ways. Practitioners need to apply cultural sensitivity and awareness of the family’s dynamics, values, and norms. They must first gather information by observing the environment, actively listening, and asking questions to better understand the families’ conditions, priorities, and preferences. All this must be done while facilitating open communication, demonstrating empathy, and promoting acceptance. These behaviors can, in turn, foster trusting relationships and enhance the practitioner’s compassionate responses by engaging in joint efforts to select meaningful and appropriate supports and individualizing goals that meet the learner as well as the family’s particular needs.

The following are some suggestions for incorporating culturally sensitive and responsive behaviors into one’s practice:

1. Cultural Norms and Values – Practitioners need to apply interpersonal skills and engage in the culturally responsive practices mentioned above. It is important to learn about available resources, levels of support with the community, and preferred language and communication modalities.
2. The Native Language of The Home – “Learning how to read or translate words into a different language is NOT synonymous with being an expert in the nuances of the language, culture, or home environment, nor does it guarantee an equal understanding of the intended meaning” (Slim & Celiberti, 2022, p. 96-97). Practitioners need to avoid jargon and attempt to seek multi-lingual translators that understand the family’s culture to convey the intended meaning of words and facilitate interactions and sharing of information.
3. Social, Economic, and Political Contexts – Practitioners need to identify the influences and contingencies to which the family is subject, across all contexts: individual, family, social-economic within the broad community, and government policy. They need to engage in reflective practices in order to ensure that their own biases do not influence the decision-making process. It is important to be aware that although social contingencies may influence the family’s life choices, it does not dictate the customs of their home environment. Furthermore, a family’s choices, priorities, and preferences are also influenced by social-economic and political contextual variables (e.g., lack of human and financial resources, social demands and restrictions, political agendas, policies).

Practitioners are better prepared to provide meaningful and individualized support when they engage in mindful attention, self-reflection, cultural responsiveness, and reciprocity; take a stance of humility; gain cultural competence skills; and adopt a flexible approach with an open mind. But let’s always remember that “while awareness and appreciation of diversity is important, relying on observable behaviors in individuals is our vaccine against prejudice” (Slim & Celiberti, 2022, p. 99).

Adriane and David: Before we finish, we’d like to take a moment to discuss your involvement with ASAT. In 2020, you accepted our nomination to the Board of Directors. How does your work with ASAT reflect the themes highlighted above both with respect to your role as well as some of our broader initiatives?

Lina: I had been a fan of ASAT for many years before I was nominated to the Board of Directors. I am passionate about helping people live a happy life, and empowering others to be their own best advocates to ensure that their voices are heard! As I mentioned earlier, I strongly believe that everyone’s voice counts and that everyone has the right to access effective and evidence-based education and treatment that is meaningful and in line with their values.

The ASAT mission to promote and disseminate safe, effective, science-based treatments that are accessible to all aligns with my values and resonates with my passion in many ways. As a practitioner, I have witnessed nationally and globally the harmful effects that unsubstantiated, inaccurate, and false information about autism treatment has on individuals on the autism spectrum. I have also witnessed the devastating effects of the adoption of pseudoscientific and fad treatments, due to a lack of resources and access to effective autism treatment. I work with ASAT on several initiatives that focus on disseminating effective science-based autism treatment to our global communities that are culturally sensitive and responsive, meaningful, informed, and person-centered. I also support ASAT initiatives focused on international dissemination efforts by increasing translation efforts for content resources and information in language that is culturally and linguistically meaningful and appropriate. Most importantly, I appreciate that access to all ASAT resources is free.

Above all, what I really love about ASAT is its unwavering dedication to adopt, without compromise, the highest standards of accountability of care, education, and treatment for individuals on the autism spectrum. I am honored to be able to dedicate my time to the Board of Directors to disseminate best practices that will lead to a better quality of life for those we serve.

Adriane and David: We would like to close on that positive note and thank you for your kind words. That was a wonderfully informative interview! Thank you so much for sharing your insight and perspectives with our readers and being so generous with your time, experience, and expertise.

References

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-220316-2.pdf

Brodhead, M. T., & Higbee, T. S. (2012). Teaching and maintaining ethical behavior in a professional organization. Behavior Analysis in Practice, 5(2), 82-88. https://doi.org/10.1037/a0032595

Fong, E. H., Catagnus, R. M., Brodhead, M. T., Quigley, S., & Field, S. (2016). Developing the cultural awareness skills of behavior analysts. Behavior analysis in practice, 9(1), 84-94. https://doi.org/10.1007/s40617-016-0111-6

Fong, E. H., & Tanaka, S. (2013). Multicultural alliance of behavior analysis standards for cultural competence in behavior analysis. International Journal of Behavioral Consultation and Therapy, 8(2), 17-19. https://doi.org/10.1037/h0100970

Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Utsey, S. O., & Terrence, T. (2013). Cultural Humility: Measuring Openness to Culturally Diverse Clients. Journal of Counseling Psychology, 60(3), 353-366. https://doi.org/10.1037/a0032595

Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. UNM Health Sciences. https://hsc.unm.edu/ipe/resources/ipec-2016-core-competencies.pdf

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. https://www.aacom.org/docs/default-source/insideome/ccrpt05-10-11.pdf

Kalyanpur, M., & Harry, B. (2012). Cultural reciprocity in special education: Building family professional relationships. Paul H. Brooks.

Sadavoy, J. A., & Zube, M. L. (Eds.). (2022). A scientific framework for compassion and social justice: Lessons in applied behavior analysis. Routledge.

Slim, L., & Celiberti, D. (2022). Cultural considerations for delivering effective treatment. In J. Sadavoy & M. Zube (Eds.), A scientific framework for compassion and social justice: Lessons from applied behaviour analysis. Routledge.

Slim, & Reuter-Yuill, L. M. (2021). A Behavior-Analytic Perspective on Interprofessional Collaboration. Behavior Analysis in Practice, 14(4), 1238–1248. https://doi.org/10.1007/s40617-021-00602-7

Spencer, T. D. (2020, March 2). Collaboration with people who think differently [Webinar]. UncomfortableX, LLC. https://www.uncomfortablex.com/events-1/collaboration-with-people-who-think-differently

Spencer, T. D., Slim, L., Cardon, T., & Morgan, L. (2021). Interprofessional collaborative practice between behavior analysts and speech-language pathologists. Association for Behavior Analysis International. https://www.abainternational.org/media/180194/abai_interprofessional_collaboration_resource_document.pdf

Citation for this article:

Miliotis, A., & Celiberti, D. (2022). An interview with Dr. Lina Slim. Science in Autism Treatment, 19(4).

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