By: Robert O’Hare, MS, BCBA, LABA-MA, LBA-NY

Individuals with any medical or psychological diagnosis have the right to access the most effective treatment options available. For individuals with an anxiety disorder, the treatment of choice is some type of Cognitive Behavioral Therapy (Kaczkurkin and Foa, 2015). The gold standard for people diagnosed with Autism Spectrum Disorder is the science of Applied Behavior Analysis, or “ABA” (CDC, 2019) ). The service delivery model for Cognitive Behavioral, speech, and occupational therapy typically involves the client going to an office within a school, clinic, or other type of support center. Providers from these respective fields also might “push into” a classroom or other setting to support the individual. 

The service delivery model in ABA, however, differs from these other fields in that it relies on one practitioner (usually a Board Certified Behavior Analyst, or “BCBA”) training other personnel to provide the service (i.e., “train-the-trainer” model). This model is necessary because the nature of ABA strategies requires continuous oversight on the part of the implementer. When these strategies are implemented consistently and accurately, individuals have an increased chance of developing the skills needed in order to function more independently. It stands to reason that an effective training approach is needed to give direct service providers the techniques to facilitate individuals’ progress toward independence.

Reid, Parsons, and Green (2012) outline the use of a training technique called Behavior Skills Training, a research-supported method for training direct service providers on how to implement strategies with individuals with developmental disabilities:

1. Clearly specify the techniques that are to be trained. 

Direct service providers cannot be expected to perform a skill competently if they are unaware of what the techniques involve.

2. Provide written guidelines of these techniques to direct service providers. 

The authors recommend giving service providers a performance checklist to support their awareness of necessary duties. It will also help to serve as a reminder of the skills that were trained and help them carry out the technique “on the job”.

3. Model implementation of these techniques for providers. 

This step involves the trainer performing the technique in front of providers so they can visualize how to do it. The authors emphasize that the trainer needs to know how to perform the skill in order to effectively show other people how to do it. The context for modeling these techniques can start in a role-play situation where the trainer is the service provider and the trainee is the individual receiving services.

4. Give service providers the opportunity to practice these techniques and give feedback as needed. 

That is, service providers are expected to perform the techniques themselves and then the trainer gives any necessary feedback to support correct implementation.

5. Rotate through steps 1, 3, and 4 until service providers’ implementation meets a predetermined performance standard. 

This means that each trainee should practice until their performance meets said standards.  Further monitoring of performance in the field with individuals will support service providers’ mastery of the skill.

Reid et al. (2012) go on to elaborate that performance expectations of direct service providers be made as transparent as possible. This is necessary so that a culture of teamwork and support be developed and the emergence of the antagonistic “us versus them” be curtailed. The authors also explain that the supervision process is ongoing and that performance checks be conducted as often as needed to ensure the provision of high-quality services. Furthermore, the training process is not considered complete until competent performance of trained skills is observed in the settings where they need to be applied (e.g., school, job site, community, or home). This is by no means an exhaustive list of all the considerations which need to be taken into account if effective services are to be delivered, but they represent a significant portion of what needs to be done if the individuals we serve are to lead as independent lives as possible.

Sources

Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin

Reid, D. H. (2012). Supervisor's guidebook: Evidence-based strategies for promoting work quality and enjoyment among human service staff.

Treatment and Intervention Services for Autism Spectrum Disorder. (2019). Centers for Disease Control and Prevention. Retrieved December 29, 2020 from https://www.cdc.gov/ncbddd/autism/treatment.html

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