Working Relationships: Applied Behavior Analysis and Speech Language Pathology
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7/21/21
Working Relationships: Applied
Behavior Analysis and Speech
Language Pathology
Joanne Gerenser, Ph. D.
Kate Grandbois, MS, CCC-SLP, BCBA, LABA
Rebecca Giammatti, MS, BCBA, LBA
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Disclosures
● Joanne Gerenser, Ph.D.
● Kate Grandbois, MS, CCC-SLP, BCBA, LABA
● Rebecca Giammatti, MS, BCBA, LBA
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7/21/21
Why do this talk?
● While never perfect, escalation of tense
relationship in recent years
● The current climate has a negative impact on
collaborative relationships
● Goal:
Improve landscape → improve collaboration → improve services
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Why should we care?
● Ethical Considerations:
○ 2.03 Consultation (b) “When indicated and professionally appropriate,
behavior analysts cooperate with other professionals, in a manner that is
consistent with the philosophical assumptions and principles of behavior
analysis, in order to effectively and appropriately serve clients.”
○ Upcoming Ethics Code 2022- 2.10 Collaborating with Colleagues.
“Behavior analysts collaborate with colleagues from their own and other
professions in the best interest of clients and stakeholders. Behavior
analysts address conflicts by compromising when possible and always
prioritizing the best interest of the client…”
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Why should we care?
Clinical Benefits:
○ For Clients-
■ Increased fidelity across treatment providers and enhanced
generalization opportunities
■ Prevents unnecessary replication or conflicting treatments
■ Reduces cost of care
○ For professionals-
■ Fosters personal and professional growth
■ Creates positive relationships
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Why should we care?
● Benefits for our field:
○ If the tide of anti-ABA rhetoric continues unchecked, our
field may cease to exist.
○ Let’s create some allies who can see the beauty of the work
we all do each day.
At this point, we still have children who are not achieving best
outcomes. We simply do NOT have all the answers and
collaborating with other disciplines/professions can only help
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Introductions: Joanne Gerenser, Ph.D.
● Began as an SLP at Eden II in 1982. At that time, Eden II was
using ABA as the primary treatment philosophy.
● Went back for a Ph.D. in Speech and Hearing Science while
working at Eden II.
● Began work on ABA-SLP Collaboration in mid 90s as ABA
became very popular and found to be the most effective when
working with individuals with ASD
● Have been Executive Director at the Eden II Programs since
1995.
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ABA before BACB actually existed!
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Introductions: Kate Grandbois, MS, CCC-SLP, BCBA
● SLP in 2007
● BCBA in 2015 → Why did I become a BCBA?
● 2015 → Present: Private Practice as an “AAC
Specialist”
○ Implementing AAC trainings, evaluations, and consulting
in ABA settings
● 2019 → Present: SLP Nerdcast
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Introductions: Rebecca Giammatti, MS, BCBA, LBA
● My start in 1999
● BCaBA then BCBA
● 15+ years on transdisciplinary teams
● Current struggles
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Learning Objectives
1. Identify at least three barriers that can interfere with BCBA/SLP
Intercollaboration
2. Describe the current landscape of BCBA/SLP Intercollaboration
3. List at least three reasons why BCBA/SLP Intercollaboration is
important when working with individuals with ASD.
4. Describe strategies that when implemented could improve
working relationships between SLPs and BCBAs
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How did we get here? A Historical Perspective
● It all began with Chomsky and Skinner in the late 50s and early 60s.
○ The Great Debate….that never happened
● The linguistic and pragmatic revolution of the 60s and 70s lead to a paradigm
shift in speech and language intervention
● While Lovaas (1973) lead to great advances in application of ABA when
working with children with ASD for behavior analysts, for SLPs, it simply
reinforced their shift
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Historical Perspective- SLP
● Prior to the 70s, many SLP programs relied on behavioral strategies to
implement programming.
● The shift to pragmatic and developmental programming moved the
disciplines apart in the 80s.
● During the 80s and early 90s, less than 5 SLPs would be in attendance at
ABAI
● Papers with ABA in them would not be accepted at ASHA during that time
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Historical Perspective- SLP
● In 1998, the BACB started and within 2 years, there was an SLP-BCBA
● The growth in dually certified SLPs grew considerably and paved the way for
a period of growing intercollaboration
● In 2016, the BACB modified its regulations and a Masters in Speech and
Hearing no longer qualified as the degree requirement portion of the BCBA
● 2018: The Neurodiversity Movement and social media
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Historical Perspective- ABA
● 50 years ahead of us...
● 1998 BACB was established
○ 1st 11 years: 5,731 total BCBA certificants
○ 11 years later: 44,025!
● The Time Before: Lovaas 1987 article and Maurice’s 1994 book
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Historical Perspective- ABA
Misinterpretation of the 2010 Guidelines for Responsible Conduct:
Taking one guideline too literally:
9.01 Promotion in Society. “The behavior analyst should promote the application of
behavioral principles in society by presenting a behavioral alternative to other procedures
or methods.”
While forgetting:
2.04 Consultation. “When indicated and professionally appropriate, behavior analysts
cooperate with other professionals in order to serve their clients effectively and
appropriately….
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Historical Perspective- ABA
“Historically, we have been a maverick group with an outsider mentality that
has been passed on to our students. We delight in asking ‘where are your
data?’ and poking fun at other models”
Foxx (1996)
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Historical Perspective- ABA
● Starting in 2001, States began enacting autism insurance reform
● Concurrently, many states enacted licensure laws, including more
stringent oversight of professional practices
○ To date approximately 17 states still have no licensure or state oversight
● By 2019, all 50 states have mandated autism coverage, solidifying
it as an industry
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Current Climate: ABA as an “industry”
● 2016: The role of Private Equity (Chung, 2018)
○ PE has created a landscape of ABA the “industry”
○ Unethical behavior in the field of ABA drive by large financial incentives
■ →workforce issues, unqualified supervision, BCBAs without adequate training
○ Rapid growth and lobbying power
● SLPs use the science of ABA in their clinical practices, but they perceive ABA
as an industry, not a science.
○ → more billable hours
○ → private clinics that perpetuate the idea that SLPs are “not needed” and “not evidence
based”
● ABA as an industry contributes to feelings of encroachment, placing a burden
on the already strained shared scope of practice.
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Current Climate: The SLP Perspective
● The ANTI-ABA movement is here.
● Dialogue → hostile argument and shaming
● Encroachment
● Operating outside of scope of competence
● Applying the science of ABA without content
knowledge
● Disciplinary centrism
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Current Climate: The BCBA Perspective
● Misinformation about the field of Speech and Language
Pathology
○ No education about our overlapping Scope of Practice
○ Evidence Based Practice (vs. Empirically validated treatment)
● Lack of training on collaboration (Kelly and Tincani, 2013)
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Current Climate: The BCBA Perspective
● Uphill battle...Our reputation precedes us:
“News Flash: Our reputation as behavior analysts isn't all that
great. In fact, there are BCBAs who, like me, sometimes hate
telling people what they do bc of the reputation that it
conjures.” (Carr, 2020)
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Current Climate: The Dually Certified Perspective
● Both sides of this debate have merit.
● Both sides have growing / work to do.
● Both sides are stakeholders for clients with ASD
● Collaboration is best for the client AND the
professional
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Current Climate: Extreme Conditions
● Tense is an understatement. It’s affecting the SLP profession
and professionals.
● Examples
○ Loss of job opportunities at the Graduate level
■ Why is this important?
→ Overlap between communication disorders and behavioral
needs (Benner, Nelson & Epstein, 2002)
→ Much of what we do as SLPs is rooted in principles of ABA
(Hegde, 1998)
○ SLPs / BCBAs being asked “hide our letters” at work
because it’s “bad for business”
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Current Climate: Extreme Conditions
● Hate mail / boycotting of services if you “like” ABA
● Calling SLPs employers with anonymous “tips” for
social media posts mentioning ABA
● Online bullying
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Current Climate: Extreme Conditions
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Barriers to Collaboration
● While these barriers below are not new, unfortunately addressing them has
become far more difficult. It’s like watching a snowstorm and wondering
when you should go out and shovel.
○ Overlapping scopes of practice and competency
○ Lack of training in how to collaborate
○ Overgeneralizing the worst of a field to all of the field
○ Failure to respect the concept of evidence based practice vs. empirically validated treatment
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Continued Barriers BCBA Perspective
● Legacy of conflicting and misinterpreted language in Ethics
Codes
● Expenses and overhead- costs of professionals’ time
● Lack of training and mentorship on collaboration and
appropriate scope of practice
● Lack of regular opportunities to collaborate, especially young
professionals
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What can we do about it?
1a. Know your scope of competence
● Self-reflect: no one knows everything!
● How do you assess your scope of
competence?
● Acknowledge implicit bias
● Humility
● Operating outside your scope is unethical
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What can we do about it?
1b. SLPs have content knowledge to contribute
● Oral motor structure and functioning
● Speech production and phonology
● Literacy (literacy is rooted in language)
● Feeding and Swallowing
● Lexical organization and processing
● AAC assessment
● Shared / different perspectives on AAC implementation
● Prosody, intonation, volume and voice
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What can we do about it?
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2. Know Your Partner
The dually certified
The behavioral SLP
The interested SLP
The tolerant SLP
The “UNDER NO CIRCUMSTANCES” SLP
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What can we do about it?
3. Meet your learner where they are!
○ Do they believe ABA is abuse? Do they have big, angry,
grumpy feelings or false beliefs about ABA?
→ Listen
→ Empathize
→ Don’t argue or “tell them the truth”
→ Your goal is to
establish a positive relationship
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What can we do about it?
3. Meet your learner where they are!
○ Are they skeptical or unsure?
→ Prioritize establishing a positive relationship
“How was your weekend?” or “I really like your shoes!”
→ Validate their perspective
“You know the student so well, what do you think about x idea?”
→ Avoid ABA jargon
→ Praise what’s working
→ Make “humble” suggestions
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What can we do about it?
● Meet your learner where they are!
○ Are they open to the idea of ABA, or open to learning
about it?
→ Prioritize establishing a positive relationship
→ Avoid ABA jargon
→ Praise what’s working
→ Make “humble” suggestions
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What can we do about it?
● Meet your learner where they are!
○ There are SLPs and other clinicians who have been using the
principles of ABA for a very long time yet chose NOT to get dually
certified.
○ Unfortunately, it has been found that BCBAs are significantly more
likely to accept recommendations from other BCBAs, when
compared to non BCBAs
Kelly & Tincani (2013)
○ Yet.. an SLP with over 30 years of work in the field of ABA may
actually be very capable of conducting an FBA (Scope of
Competence)
○ These are potential allies and should be easy collaborators
○ Take time to get to know your potential collaborators
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What can we do about it?
● Set up organizational structures that make collaboration
possible and fluent
○ Relationship building time
○ Scheduled collaboration meetings
○ Share treatment plans prior to submission to insurance or parents
● Invite SLPs to present at in-house professional development
presentations and include collaborators in team building
activities
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What can we do about it?
Training!
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Final Thoughts
● Effective communication is considered a core feature of effective
intercollaboration. How you chose to communicate right from the start will
have a big impact on any possibility of success.
● Connect as people. Consider having lunch together or even better,
collaborating on a presentation. (make a few emotional deposits before
beginning to withdraw)
● Conflict should not be seen as bad. Conflict with TRUST is actually the
search for truth. Conflict without trust is just that….Conflict!
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Final Thoughts
1.10 Awareness of Personal Biases and Challenges Behavior analysts maintain
awareness that their personal biases or challenges (e.g., mental or physical health
conditions; legal, financial, marital/relationship challenges) may interfere with the
effectiveness of their professional work. Behavior analysts take appropriate steps
to resolve interference, ensure that their professional work is not compromised,
and document all actions taken in this circumstance and the eventual outcomes.
2.10 Collaborating with Colleagues Behavior analysts collaborate with colleagues
from their own and other professions in the best interest of clients and
stakeholders. Behavior analysts address conflicts by compromising when
possible and always prioritizing the best interest of the client. Behavior analysts
document all actions taken in these circumstances and their eventual outcomes.
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