DEI, OBM and ABA with Portia James, BCBA (Part I)

ABA on Tap is so proud to spend some time with the illustrious Portia James. (Part 1 of 2)

As a visionary, a powerhouse of a leader, and a pioneer for women and people of color in her field, Portia James has been shaking conference room tables for nearly two decades. She shares bold perspectives on the lack of representation for black leadership in the workplace and how it impacts decision-making and strategic execution at the executive level. She is one of few Behavior Analysts to have been featured in both Forbes and Harvard Business Review.

Portia is a sought-after Board Certified Behavior Analyst and Organizational Behavior Management specialist who helps black Behavior Analysts launch and scale companies that thrive. As the founder and CEO of Behavior Genius, she has served hundreds of staff and families impacted by Autism.

Portia is a wife to an MMA fighter (of course she is!)  and mother of 3 dynamic children, a travel junkie, and a red wine enthusiast. Portia serves up a flight of bold and complex flavors. Sip this one slowly and carefully. Don't forget to swirl, take in the bouquet, and always analyze responsibly. 

Transcript

Copy

SPEAKER_02 0:00

Welcome to ABA on Tap, where our goal is to find the best recipe to brew the smoothest, coldest, and best tasting ABA around. I'm Dan Lowry with Mike Rubio, and join us on our journey as we look back into the ingredients to form the best concoction of ABA on tap. In this podcast, we will talk about the history of the ABA brew, how much to consume to achieve the optimum buzz while not getting too drunk, and the recommended pairings to bring to the table. So without further ado, sit back, relax, and always analyze responsibly. Thank you.

SPEAKER_04 0:54

All right, all right. Welcome back to yet another installment of ABA on Tap. I am your ever-grateful co-host, Mike Rubio, along with Mr. Daniel Lowry. Mr. Dan, it's a Friday, sir. That's unusual for us. It's great to see you. We're here on a Friday. Clearly, we've got something special.

SPEAKER_02 1:14

I'm super excited to be here on a Friday, on a lunch break in between your clients while you've been able to accommodate because we were so excited to have Portia on. So yeah, changing the Sunday vibes for the Friday vibes. So the weekend is about to be upon us.

SPEAKER_04 1:28

Now, I heard our guest today, our guest Portia James, might be talking to us about systemic variables and burnout in our industry. And as you said, I'm literally on a lunch break between clients. We're very proud business owners of a new ABA venture, medical services, autism treatment. So this is just the name of the game. And this was scheduled way before we had new clients and new employees to support. So I'm very glad to be here on a lunch break. Very excited. So without further ado, Our guest, Portia James. Hey, hey. Hey,

SPEAKER_00 2:10

hey.

UNKNOWN 2:10

Come on over.

SPEAKER_04 2:10

All right. Portia, how are you doing? We're so grateful for your time. You might be on your lunch break. How are you doing today?

SPEAKER_01 2:17

I am on my lunch break. There's no lunch on my desk because my husband is gone for the day, but I'm doing well. I'm grateful to be here. I'm really

SPEAKER_04 2:27

excited. Thank you so much for your time. We know you keep very busy. You've got some very important things to share with us today. We're very happy to talk to people who are not directly necessarily working maybe on autism intervention services, but have taken a broader scope, which I think is very important to the growth of our field. I think you've got a lot of things to share with us about that today. We love to start with the origin story. Tell us how you got started in ABA, what other things are part of your background, what keeps you driven, family, anything that you want people to know out there. Give us the origin story, Portia.

SPEAKER_01 3:07

Yeah, absolutely. Oh gosh, where do I start? So I have been in ABA for almost 20 years. Actually, I'll be at 19 years this June 3rd since I started in ABA. Congratulations. Shout

SPEAKER_02 3:22

out to you. Oh,

SPEAKER_01 3:23

thank you. I'll be doing a big, I'll be doing a world tour next year.

SPEAKER_02 3:28

The 20th anniversary.

SPEAKER_04 3:29

We better get noticed. I want a shirt. I want

SPEAKER_01 3:32

a shirt for sure. I'll have t-shirts. I'll have CD covers. A hat. All of that. Okay, perfect. So I started as a behavior technician during my undergraduate internship, and I just have kind of throughout the years worked my way up. In Southern California, we have the mid-tier for most of our insurance companies. I work with a lot of Medi-Cal, Medicaid clients. And so I had the mid-tier. I then got my BCBA in 2011. And so excited to continue, I think, in work that I loved back then when I was in home. And I never imagined that I would love that. not being with my kids or not being with my uh family but over the years i just kind of like took the slow road and i grew and i had a lot of different opportunities to practice teaching the principles of behavior analysis, not only to people that I managed and mentored, but also to families. And so I've had some pretty interesting opportunities to train the San Bernardino County Sheriff's Department graduating class in behavioral strategies and recognizing signs of autism, and how those differ from like, you know, signs of, you other distress, mental illness and things like that. I had the opportunity to teach parent training for the Inland Regional Center. I served for a little while as the behavior consultant for Pomona Unified School District. So I got to go in and do all of their teacher in-service days. My master's is actually in teaching. So at that time, I was using my master's to teach teachers how to set up their classrooms so that they could be effective with kids with autism. That was a really fun So for me, I think just throughout the years, what I've enjoyed most is being able to expand upon just general ABA in-home services. I do have three children. I should mention them. I've been married for nine years this summer, and I do have three children. They are typically developing children, ages 16, 10, and 6. So they keep me very busy. I'm a homeschool mom as well. Wow.

SPEAKER_02 5:47

well thank you for giving us some time man

SPEAKER_01 5:51

this

SPEAKER_04 5:53

is an extended recess is that what's going on here

SPEAKER_01 5:56

yeah this is actually it's Friday Fridays are fun Fridays yeah my husband trains Jiu Jitsu he is working on his black belt but he has a couple fighters that he manages and so it's fight weekend and so my kids are gone and my husband just left so that they can go do what they need to do to get ready for fight weekend Very different life than the NBA life.

SPEAKER_00 6:20

Wow.

SPEAKER_02 6:21

Wow. Yeah, I'm a huge UFC fan, so I love the jiu-jitsu stuff. Yes, big UFC fans. My kids, too.

SPEAKER_04 6:28

I catch it here and there. I catch it here and there. That's a very dynamic family you just described. Congratulations. Three great kids. Nice working on the extended prolonged marriage. That's an incredible thing, especially these days. You say typically developing, and I think that's a really... poignant statement to make, especially when we're talking about, say, autism services or ABA services for autism intervention. How would you differentiate being a parent, not that either of us would know being a parent of a neurodivergent child, for example, but you made an important differentiation there. Tell us about it. What do you think the difference is in what you do and what a parent with an autistic child might be doing? And then where are the commonalities, perhaps?

SPEAKER_01 7:16

Yeah, I mean, I think parenting is hard. Common parenting is challenging.

SPEAKER_00 7:22

It

SPEAKER_01 7:22

challenges, it grows us. But I've been in human analysis longer than I've been a mom. And so I'm always really careful to make sure that I'm clear with respect and honor to parents who do parent children who have special needs or are neurodiverse. I think it's important to recognize the things that we take for granted as parents, the little things that we get access to, the experiences that we get to have, the conversations that we get to have with our kids, even the things that agitate us, right? Like arguing back with them. But getting to do that, right? And I've worked with so many kids who either didn't have language or, you know, we're not able, we're teaching negotiating, right? We're teaching how to answer a question about how school was today. My kids, they were able to pick up developmental milestones just by being with other kids. And even though there's research that suggests that when you put any kid, a neurodiverse child as well, with a, another child peer mediated learning is so robust. Um, however, the rate, the pace at learning, right? So there's things that my kids just kind of picked up and I was like, who taught you how to read? Um, that the kids that I, that I've historically worked with, we've had, I, I, I know what it was like spending six months or a year, 18 months potty training, a child working the parent through the things that, you know, just, I had parents that would say, Oh, if I could wave a magic wand, I would just want my child to be able to tell me if they got hurt today at school or if their stomach hurts or, you know, things like that. And so I always want to make sure that, that I do, I get asked a lot. Do you have children on the spectrum? And I do not have children on the spectrum. My kids are very different. Their, their needs are different. Their demands are different. But I do recognize how privileged I am to have children that are, I don't have to step out of the average typical difficulties of parenting in order to parent my child. We don't have three or four different types of therapies. I'm not fighting the school district. And so I think that those things need to be acknowledged because parenting is generally hard. But when you add the layers and layers of life that most of my parents have had to add, it becomes, I just told you about the dynamic, like nature of my life. Now, imagine if I had a child who had speech and occupational therapy and IEP meetings and, and also just wasn't able to maybe go with the flow of the way that we have a very loose, loose life schedule. Um, we don't have very strict adherence to really any routine. Yeah. So we have fun Friday that is within our routine, but yeah, I just, I acknowledge that because, um, I think that when we're talking about ABA and autism, it's also important to acknowledge that I do have three children and as much work as it is, it will never even hold a candle to some of the experiences that I've seen my families have to add to their agendas, but also the things that they miss out on, the normal going out to dinner, the going to the grocery store, being with family at parties, having a babysitter so they can go to date night, things like that, that our parents, the parents that I've served have just really missed because they have been caring for their child in ways that most of us really could never imagine.

SPEAKER_04 11:03

Thank you for that perspective. I think you You hit a lot of important pieces that really could guide us as service providers in terms of what things we recommend. What are we suggesting the parents are doing to actually address some of the challenges, behaviorally or otherwise? Sometimes we can load up that plate a lot more than it needs to be loaded up, and I think that teaches us a lot about how to be mindful. I know I've said it. a million times, so to speak, here on the podcast. But to your point, Portia, the idea that I've got three children myself. I've got two teenagers and then a younger four-year-old. And every time

SPEAKER_01 11:42

I... That's not starting over. Yeah, yes,

SPEAKER_04 11:44

exactly, exactly. Now I have to practice what he reaches. Glutton for punishment. I think she was for training purposes, right? I was starting a business, early start, intervention. She has to train me. But I like to say that with every one of my children, I get 1,000% better at what I do professionally because I gain a whole new perspective now and having two children and understanding what that balance is and then now the third children certain age discrepancy and then to your point most importantly adding all these layers of intervention the stress of now discussing an IEP as much as it's a useful service it comes with a lot of work so I think that's a really important perspective that you you lent to us there thank you so much

SPEAKER_02 12:25

Yeah. You mentioned that you've done, you did parent training for the regional center out in Pomona. Was that correct? The Pomona Regional Center?

SPEAKER_01 12:33

It was the Inland Regional Center. So they're located in San Bernardino.

SPEAKER_02 12:38

San Bernardino for the regional center. But before that, you worked with law enforcement, right? The San Bernardino Sheriffs?

SPEAKER_01 12:45

I did. I didn't work with them. I actually just had an opportunity from a parent who was going through the graduating class. She had a child with autism and she said, you need to come and speak to them because there was a child who was killed and by the police, not in San Bernardino, but in another state. She heard about it and she said, this could be my child. This could be any of our kids. And there is no the training that we that we are required to do is not sufficient. Will you come and speak to my graduating class? And so, of course, of course, I was open to that.

SPEAKER_02 13:20

There was just an individual that made the national maybe in Boise or something that individual with special needs that got killed by the. Police, like a month ago or something, made national news. And again, it's not cut and dry, but that's certainly a need. In San Diego, we have the PERT team. I think it's the Psychiatric Emergency Response Team. There you go.

SPEAKER_04 13:46

Is that just particular to San Diego County?

SPEAKER_02 13:48

No, I think, but I know we have that in San Diego County. So can you talk a little bit about your experience in talking with these individuals? Did you find that they were receptive? And the reason I ask is I work for a company also called Proact. Are you familiar with Proact?

SPEAKER_01 14:03

Yeah, I am.

SPEAKER_02 14:03

Okay. So I worked for a company called Proact and, you know, we teach a lot of de-escalation and crisis management strategies. And we don't train a whole lot of current law enforcement, but a lot of ex-law enforcement. And the ways that they go about things sometimes isn't the ways that we would teach going about things, about maybe client empowerment and offering alternatives and things like that. So can you speak to maybe that experience? Because I'm really interested to hear your experience with law enforcement, how they were receptive, what you said. Can you take us in that conference room?

SPEAKER_01 14:36

Sure. It was very eye-opening. I don't have good news to report. It was eye-opening for me because I was younger. This is a really long time ago. Maybe 15 years. Maybe 12 to 15 years ago. And I went in, I am a very positive person. We gather that

SPEAKER_04 15:06

immediately. We appreciate it. Thank you.

SPEAKER_01 15:08

Thank you. I try to stay on the up and up, you know? So I went in, I have my little presentation and I was just like, I'm going to change their perspectives. It's going to be so beautiful. We're going to come together. We're going to do a handshake and everybody's going to think kumbaya. And it was tough. It was really tough because they were engaged. They were engaged. I spoke to them about how to identify some of the differences, behaviors that they may see. So, for example, they need to know if a person is nonverbal, they may not be ignoring them or how a person with autism may respond to being afraid. Right. So aggression, even aggressive behavior could be fear. Right. And how that might talk them through, like how that might look different than schizophrenia or, you know, if they were to find someone, how they can get informed, who should probably be with that person. If a parent calls them, the types of questions that they should ask before they go out or when they get there. Just how to assess the situation a little bit better is what I really wanted. There's not much I could do in like a two to three hour presentation. But it was really interesting because there were some, and maybe it was that the officers who may have had children with autism or no children with autism that seemed really appreciative that were like, yes, this changes me forever. I would say out of about 50 of them, there may have been two or three that were like, I'm forever changed. Thank you for sharing this. I will be more mindful. Um, during my presentation, I shared an example of a child who was shot, um, he was chasing his mom around the kitchen Island with a knife over a butter knife, a butter knife over a bag of Skittles. Um, and he was denied access to this candy and it made national news and I had heard about it. So I was like, perfect. I'm going to use this as an example. Um, because you know, law enforcement really wants us to know what, that their job, I think what I learned is that their job is to eliminate risk. However, because of what they do, their perception of risk is much higher than ours. Now you would think like in some situations, like my husband, he's a fighter, right? So he goes into the cage and he does mixed martial arts. And so for him, the perception of danger is is he has a higher threshold because he has been punched in the face on purpose for fun, right? So for him, he's like, I know it sounds scary to you guys, but for me, once you've done it a couple of times, it's just not that big

SPEAKER_00 17:50

a deal.

SPEAKER_01 17:51

For police officers, I almost feel like they have this response. They're trained to see danger in everyday things, which is something that we can understand,

SPEAKER_00 18:02

right?

SPEAKER_01 18:03

And so- it almost feels like their threshold for danger is even lower. And so I learned a couple of things. Number one, they're not trained. And my husband always says, why don't they just learn how to fight? Yeah. Yeah. Why shouldn't they all have to take my martial arts class? But I learned that number one, a lot of them, and they all agreed with each other at the end of the day, I will go out and protect and serve, but my mission is to make it home. At the end of the night, I'm first, right? Like whatever. And I would rather accidentally pull the trigger than to not make it home, than to be too slow and not to make it home tonight to my own family and my wife. And so there's that. And then they also don't shoot to incapacitate. they're trained that if you draw, they have these other levels, right? So they have the baton, they have taser, they have pepper spray. Um, if you draw your weapon, you must shoot to kill. That is the intention, right? And so there is never an intention to draw your weapon, to shoot someone in the, in the, and I hate to like talk about this cause I might be wrong, but this is what they shared with me. There could have been reform in the last 15 years. Maybe there's

SPEAKER_00 19:23

been some type of reform,

SPEAKER_01 19:24

but this is what I understood. And so, um, Number one, they do need to go through those different levels. However, based on the type of risk or the speed of the risk, they may skip the levels and go straight to their weapon. And so what I learned from having that conversation was that, and I showed them and I was like, what would you have done in this situation? Here's a video of this little boy. He has a butter knife. Butter knife is probably not going to kill you. And it was so interesting because they were like, how do we know the butter knife is going to kill us? You could take out someone's carotid with a butter knife. You could take an eye out with a butter knife. It was just things that for me, I'm like, I would wrestle the butter knife out of this kid's hand. That's what I would have to do because I'm not allowed to, I don't have any their weapons. For sure. I know a lot of

SPEAKER_04 20:12

entry-level RBTs would have de-escalated the situation with a

SPEAKER_01 20:17

butter knife. A kid with a butter knife is like not okay. But that's us too, working with kids with autism. We're like, kid with a butter knife, no big deal, right? And so for them, they're like, it was a weapon. And so they feel like a weapon is a weapon is a weapon. And so what I learned living and working, I was born and raised in San Bernardino County. Um, and so, and I work with, because of that, because I've worked in San Bernardino County, I work with a lot of black and brown children. And, um, back then the race conversation was not on the table. That's not what we were there to talk about. Um, I evolved in my career to, to be comfortable enough, having the race conversations because they were very real to the families that I served and they were necessary because the families had to understand what they were up against. So what that taught me is, was number one, have the race conversation with my families and to let them know what police said, which was, this is what we're going to do. And 90% of them were like, not budging. This is how we're trained. This is what we do. And this is what's going to happen. And so the, the work, the onus then became, I felt on me on service providers to keep our kids out of the system. So my, I started to shift after that because I was like, great, we're probably not going to change how they behave. respond because they're actually doing their job and the system is working the way that it was designed to work for them, right? We can't manage them, they don't work for us. But what we can do is we can educate parents and we can educate our team and we can make sure that the behavior team is equipped to be able to work with families who do have a risk of their children ending up coming into contact with law enforcement. So children with autism are eight times more likely to come into contact with law enforcement. And then when you compound that, make that a child of color, it's compounded on top of that. And so the likelihood that these kids with these behavioral health issues are going to come into contact with law enforcement, it's very high. So I started to take my job very seriously and have conversations with families about what the trajectory looked like based on data for their child if we did not work on managing their behavior while we could. That's really what I took from it. And I think that really kicked off, even just that memory kicked off. It took me on a whole different journey in ABA because ABA became a matter of social significance in a different way and because the social justice piece I understood it better and I was able to speak to this is what they're saying and we can keep trying to fight against them but these men are doing their job the way that they were trained to do it whether it's right or wrong are we doing our jobs the way that we were trained to do it right and are we aware enough of what's happening in terms of society to say well how can I prepare my child to exist in a society like this If we can't change the society, can we help our families to help their kids exist safely in a society where this is the reality?

SPEAKER_02 23:27

Wow. Thank you. I never thought about that. And that even gives, honestly, a new thought to even receptive instructions, right? We work on basic one-step receptive instructions with a lot of our students. individuals. Historically, it would be much more decontextualized. Touch your nose or spin around or things like that. Now, it's more contextualized where we try to make it have a meaning rather than just random instructions. I'm thinking about that in relationship to what you said with law enforcement. A lot of our kids that we work with or individuals that we work with really struggle with that receptive instructions. As law enforcement is you're expecting that person that you're giving that demand to, to respond immediately, you know, get down or whatever it is, put the knife down immediately. And that person, like you said, might be nonverbal, but even receptively might not understand that instruction or might not follow that instruction. And it's just really interesting because we talk about, you know, the stakes in an ABA session are whatever the reinforcers at the time, but You're talking about the stakes could be life or death. And that's thank you for sharing that, because that's really it's unfortunate, but it's also very eye opening.

SPEAKER_01 24:38

Yeah, they really are life or death. I was having a recent conversation with someone that is working on ascent. And so her her her the center that she works in the treatment center that she works in, they're putting in place ascent based trainings for their team members and That's our name of our

SPEAKER_02 24:54

company, Ascend Behavioral Solutions for Ascent. Oh,

SPEAKER_01 24:57

beautiful. Well, this may help. So the team is talking about, hey, you know, the kids, you need to ascend to services, whether or not they are, you know, we've got to let kids have choices and things like that. And she says, yes, you know, but what her question was, I coach her. And so her question to me was, how do I explain to them that in some families and also in society for some children, um, the right to choose does not exist. The right to say no does not exist. So, um, how, how do I, you know, first of all, in black families, kids don't get to have a scent. We don't, we don't, we don't consent to, to when we were being raised and we didn't have a choice about anything that we were told to be right. And so, um, so these kids are going to get in trouble at the lowest level. We're going to get them in trouble with their parents or parents don't want us to teach that the kids that it's okay to say no or it's okay to refuse or it's okay you know and and so she was saying like if you come into contact with law enforcement you don't get to have a conversation about whether or not you consent to however however it is that they are approaching you you have to follow every single instruction immediately to a tee and so what I shared with her was I said well this is really easy if we want to make it a little bit like simpler for just ABA to understand is we can teach assent safely and If we make sure that we also teach the child conditional discrimination. So these are the situations where you would have a choice and where you would be able to say, no, I don't want to, or can I have more time? And these are the situations where... you just follow the instruction immediately. So safety, if you're running into the street and I yell stop, you don't get to think about whether or not you're gonna, you're actually gonna stop because now it's a safety concern. There was a child last February named Ryan Gaynor who was killed in his front yard in Apple Valley. Just a couple of, we served this area. Could have very well been our client. I was very emotionally like drawn to his case. And he was running when the police showed up He was running out of the house with a garden tool. And when the police said, stop, stop, stop, don't come any further. And he was not able to respond to that instruction. And within, I think it was like 12 seconds of the police showing up on the scene, they did tell him to stop. There's body camera footage of, you know, he was running out of the house with this tool and he was shot and killed in his front yard. over parents just calling for help because he was having, he was in behavioral crisis. And so for me, what I felt like was, of course, there was a big social justice issue there. We went to the press release and we got to be a part of it. But the issue for me was, where was his behavior team? And why did the parents have to call the police? Because once the police show up, they do have to do their job. And again, in the way that they're taught to do it. Um, and so that's just an example of like, yeah, the, the client or the person might not be able to respond. Um, how can we keep them out of the relationship with law enforcement for as long as we can or forever, right. And, or give them the tools to navigate law enforcement even for some of these, um, some of these kids, because it is their reality that they will come into contact and they do need to know how to respond in those situations.

SPEAKER_04 28:28

Wow. That's, um, Let's think of hypotheticals here. I mean, you mentioned even the way the process is in taking that emergency call. We can start looking at the language the parent would use that might alert those people to maybe show up with rubber bullets. I'm trying to get to a point where there is a greater level of understanding, despite your very... astute observation that we're not going to change that protocol in terms of my baton, my spray, my taser, now I'm shooting to kill. And again, I love the way you posit that protocol for them and the idea that you say, look, we're likely not going to change that. So what are we doing on the other end? And then maybe to push on that question a little bit more, I mean, what else could be done to really inform, and you probably have some of these answers, Portia, inform parents on how they even approach first this crisis management system before that system, then enacts the police that then is much better informed about the situation and how to escalate it in a way that can maybe avoid death. You know, again, maybe I'm asking some very open-ended questions, but give us your insight as far as your work goes.

SPEAKER_01 29:50

Yeah, well, I think coordination of care is on the back burner for a lot of ABA providers, right? Something that the insurance says we should be doing. It's very unregulated

SPEAKER_00 30:00

at most ABA companies. Excellent

SPEAKER_01 30:01

point. Mine included, like I didn't have a code, a special label or anything inside of our scheduler that our team could use labels to say this particular phone call was coordination of care. And I think because we have such a young audience, providers in ABA, I don't know if they're intimidated, or they're just not being taught how to coordinate care, not only with it, they're showing up to school, they know the teacher, they know the speech therapist. But I mean, I've coordinated care with every single I made a point to say who all do anything, who is all a member of this child's life. Who is in this job? Like, Grandma, bring me Grandma. I want to know the people at church. I want to be familiar with the doctor if they're prescribing medications. A lot of times we don't get into that because ABA is a very rigid field. And people in ABA can be very rigid.

SPEAKER_02 30:58

That's

SPEAKER_01 30:58

an understatement. Yeah, well, thank you. I try to use the word very to make sure that it's like, but yeah, it's the rigidity that will say, well, that's outside of my scope. And it's like, well, first of all, human behavior is not outside of your scope. And all the areas where human behavior exists, you do have to be able to navigate at least conversations around how things impact you. human behavior and so um if we have i years and years back i had a kid who he was engaging in high levels of aggression um and his parents were getting older dad had a bad back and he's like we got to do something we never wanted to do medication we reduced the behavior enough and frequency but the intensity when he did engage in the behavior the intensity was still very high and parents could not control it um and so what they did was they first of all they asked me what i thought about medication and i stuck to my ethics code and i let them know I don't, I don't think about medication. Um, but if they're going to walk that journey with their child, um, that I can help pinpoint what happens to the child's behavior when medications are added. And so I had a relationship with, um, the doctor who would always let me know if there was a small change, even if it was like a 0.02, um, on the dosage or whatever. And I would drop phase change lines every single time there was a change because they titrated him up really slowly. Um, We looked at that data very, very closely. And what I noticed is that they were giving this child medication for like psychiatric medication for outbursts, for aggression. I think it was like Abilify. So, of course, kid gained a bunch of weight. Like, you know, it was just pretty bad. But he was a zombie. So behavior did kind of stop. He wasn't really himself. And parents just didn't like it. So they went to the drawing board. And so the doctor is like, OK, so what I was able to explain to the doctor was what's actually happening. The underlying cause of this behavior is that he has obsessive thoughts. It wasn't necessarily like a matter of he's just an aggressive child because he wasn't. He had obsessive thoughts. And what was happening behaviorally was that he would just think about something over and over and ask for it over and over. And every time he got a no, he would. become aggressive again. So then he may stop after a while, like, okay, I'm not going to ask for trains for a week, but if I see a train now, here I go for this next week, I'm going to have a problem because I'm going to ask to go and buy a train and see a train near the train and all of that. And so if we could stop him from, if he could get over it, right? Like we said, no. And then that's it. If we could stop him. Cause we tried on the behavior side, we tried to get him to like, Hey, we were even recording number of times he would ask after he was told no, like tally every single time he asked, see if we can reduce the number of times that he would ask, right? Like a DRL. That's probably the only time I ever use it. And so, and we were able to get it down to an extent, but again, when he, whenever he would think about it again, he would, he would escalate and the intensity was so high. So I let the doctor know, I don't know if this would be appropriate, but is there a medication that would, that would deal with the underlying cause of the obsession? Like something that you would give someone for OCD instead of something that you would give someone for like psychiatric, you know? And so the doctor was like, you know, that does make sense. Parents were willing to try it. That's the medication that he was prescribed. And we saw, huge improvements in his behavior because he was able to tolerate no, because the obsession was, was stopped. So, but I think that the coordination of care to that extent is necessary to protect children, you know, socially, especially as they get older, we have to be willing to have conversations with every single person that touches the kid, especially these kids. And also we have to be willing to understand other diagnoses outside of autism. And also understand other services that can exist either through our organizations or that already exists in the community that are not just for children with autism. They think that's where we put ourselves into a box and we're not really providing the service to every child who needs it in the way that they need it because we are thinking about how to treat autism. And that is limiting. It's limiting how effective we can be with the science and all the different places where we can apply the science. to meet the needs of the kids.

SPEAKER_04 35:30

I really enjoyed that account of collaborative treatment. I mean, that can be very time-consuming, very difficult to achieve. I commend you on your efforts to maybe... engage another camp that can be a little bit difficult to engage that being, uh, physicians. Was this a specialist? Was this the child's pediatrician? Do you recall?

SPEAKER_01 35:52

It was, um, it was a psychiatrist, a child psychologist. So it wasn't, or his psychiatrist, it wasn't his primary care, but he had had a psychiatrist dealing with his medications for a while.

SPEAKER_04 36:03

That's incredible.

SPEAKER_02 36:04

My buddy's a psychiatrist and he talks about how a lot of the medications are off label for kids. There's not a lot of on label medications for kids and it's very interesting how because we've taken part of some of the psychiatrist visits and how a lot of times they're 15 minutes and it's like how are things going and the parents are like it's terrible and it's like okay well do we need to increase the medication do we need to change the medication and i'm sitting there thinking about it's terrible is that just the medication? Uh, are we sure that that's the reason? Could there be other stressors in the environment? Could the parents be responding or not responding correctly? Um, so it's very interesting how, um, and I know this is making it seem like I'm anti-medication. I'm not saying that at all. Um, that's just one variable in a very multivariate situation, but has huge side effects as those medications are titrated and changed. And I just, you made me think about it with your example, how so often these things are kind of changed willy nilly, uh, With so, so many side effects. And maybe it's like you said, maybe even not even the right medication or maybe it is the right medication, but the parents not doing the behavioral protocols that are recommended by the behavioral team. So it is.

SPEAKER_01 37:16

And the thing about medication, I don't, I don't know if I'm anti-medication, but what I'll say is that I do think, well, you know, ABA would say rule out medical issues first. That's what science says. But then at the same time, I feel like we should rule out whether or not our behavior plan works before we venture into medication. Because once the child is on medication, if the medication works... then we don't get to ever know if our intervention could have worked without medication. So if the medication actually removes the behavior from being a problem, sure, we can teach all these skills. But unless this family, and most families do not, but unless this family wants their child to be on medication forever, and that to be what's actually managing their child's behavior and the only thing that's managing their child's behavior, we do have to find out Can we see behavioral progress without the medication? Will the child ever be able to be off of their medication? And that's where it just gets kind of like sticky, right? Because we believe that sometimes parents will medicate their kids because they don't know what to do and they don't have the support. But you can send the right behavior analyst in there. And I've had kids that have come off of their medication, right? Where we've slowly titrated them off their medication. It should be the goal, right? Yeah, absolutely. But you have to be able to collaborate with their doctor and with the family to be able to do that.

SPEAKER_02 38:41

Yeah, absolutely. In my experience, medication is most effective when I have an individual that I'm working with that is not able to be receptive or accessible to the behavioral treatment because of maybe they have an obsessive thoughts or maybe they're just so overstimulated. They're not able to even attend for a second or they're the opposite. They're so understimulated. They're just like checked out. So maybe that's just my personal experience that that's what medication can be very useful to help that individual get in the best physiological state to be receptive to the treatment and hope that the behavioral treatment will take over and then we can titrate the medication down over time.

SPEAKER_01 39:20

Yeah, because they're going to give it to you. If a parent goes in and asks for the medication, they're going to give it to you. It's the diagnosis that I'm always concerned about because what are we medicating? Are we medicating some psychiatric issue? Does this child have schizophrenia and that's what we're medicating? Okay, that makes sense. But if we're just medicating, you know, aggressive behavior, there should be a diagnosis connected to that outside of autism before medications are given.

SPEAKER_04 39:49

You alluded to this. Is there to date an autism specific medication or are we doing everything off label still?

SPEAKER_02 39:57

I can't speak to... I know my psychiatrist friend said the majority of it's off-label. I don't mean that means all of it's off-label.

SPEAKER_04 40:04

I'm not sure if there's been something approved specifically for autism treatment, to your point, Portia. I think that's a really important point. I ventured into that with... We were part of a group that was actually an extension. We were the ABA department at psychiatric... a series of psychiatric centers and clinics here in San Diego for a little while. And we did try to interface with the psychiatrist there to some minimal success. Again, I think Dan alluded to the point earlier about, you know, we have these 15 minute consultations, don't necessarily have a whole lot of time for your guys' questions. But again, they were receptive to some of the experiences, we were able to learn a little bit more about how to help them as part of the behavior service. And then I remember venturing into the idea of what we're talking about, I guess, in a sense is neuropsychopharmacology, right? Seeing the effects of a medication on the behavior, which to your point, Portia, we don't talk about enough. Maybe we should talk about more in terms of phase change lines and really understanding how the medications work. And that's where I'll kind of pose this question in terms of, maybe teaching parents about the side effects, the therapeutic effects, knowing that sometimes side effects can discourage a family from using medication, but those can be behaviorally managed as well. The idea that therapeutic effects should be reinforced. If your child is now, some of those behaviors went away and they're responding more, that's something that we need to be ready for behaviorally to provide reinforcement and really make it a collaborative treatment between the behavior and the medication. And then maybe understanding some pieces like, you know, stimulant medication with regard to, say, a comorbid ADHD diagnosis doesn't necessarily mean your child is going to sit down and attend. In fact, one of the therapeutic effects might be that they might move around more, in which case, are you ready to then incite the learning process? So I don't really have a question, but I think you bring up a lot of those points that maybe we don't look at closely enough. I just happen to have a little bit of a background in graduate school, so I've always been interested in that. And I remember having this conversation with you early on and saying, wait, so getting the prescription is one thing, the endogenous changes is the other thing, but even getting that pill into your mouth, that's... behavioral that's us yeah and we don't even think about that right so the idea that hey my child's chewing on their shirt we stopped the medication over the weekend okay is that what your psychiatrist wanted you to do because these things have to compound there's a as an upgrade time there's you know a lot of things that happen so anyway i just i'll put that out there for commentary

SPEAKER_02 42:48

i do have a question for you um so you talked about the importance of collaboration of care um one thing that i've seen in san diego and i mean we're a pretty big city um we theoretically have a lot of resources but sometimes that collaboration of care breaks down I remember I had a 16 year old that was constantly running away from the home and we would set these contingencies and the parents would even try to you know nail the windows shut and stuff like that but the individual would be able to find ways out and maybe if I was with them longer we could have you know, found like, you know, short of putting them in a prison cell, like they could see 16, he'd be able to find a way out. So we talked to the regional center here. Um, and again, the resources for that kind of stuff was very limited. It was kind of like, well, if they run away, call the cops, but you're talking about try the ways of us keeping them out of that system. But sometimes it seems like the resources and the care that there's like something missing that could be there to keep them out of the system. Um, But either that's we don't know where that is and how to refer them there or that's not there and it should be there. Can you speak

SPEAKER_01 43:54

to that? Yeah. Sure. I think, um, there are, there are missing holes. Um, there's either like the, the resource is missing or the relationship is missing and we don't know unless we explore the relationship. Right. So, um, last year I did a kind of like a, it's a CEU event and it was called We The People. Um, and it was about Ryan Gaynor, this child who was killed. And it was like, what else could we have been done? Like what was missing from this? his family support system. Um, because we have to start thinking like, what are the family support systems that exist

SPEAKER_00 44:26

already

SPEAKER_01 44:27

just in the area? Um, and I learned so much, like I learned that, um, They were calling the police. They had called the police five times and the police did not come out. They had come out a few times, but this particular time they didn't come out. They referred them to psych. So they were like taken to the hospital. So they took them to the hospital. And so on with the people, the point of it was collaborative. So we had different players in the community attend the CEU event for a panel conversation. And so there was a social worker, a licensed clinical social worker that was there. And she was like, well, what happens is the police will refer them to the hospital.

SPEAKER_00 45:09

And

SPEAKER_01 45:10

then when we get them to the hospital, it's our job just to get them stable and then release them.

SPEAKER_02 45:15

Exactly.

SPEAKER_01 45:16

And I was like, okay, so what is stable? If you give them the medication or you just keep them in the hospital room until the behavior is passed and then you just send them right back with their parents. You don't send them with any resources. You don't send them with next steps. You don't speak to their behavior team. You just... Send them out, stabilize them and send them out. So it's like, wow. So even just understanding what happens in all of these, like what happens in the chain of events. So how does it get to law enforcement? And of course, law enforcement was like, we do have emergency response teams. But number one, the emergency response teams were coming out getting hurt. And so they didn't want to come out anymore because they're coming out unarmed. coming out and getting hurt because they weren't they weren't behaviorally trained or supposedly they were but then they they didn't want to do this anymore because they were getting hurt so um so they were like so we just started referring back to hospitalization well then once that child gets off of their 51 50 72 hour hold they're just standing back with no resources so it's like when the child is on the hold or in the hospital is there um a behavior analysis unit that comes to that child's family and talks to them about what they have in place and what resources are available to them so that when they are discharged, the family, they can help the family tap into these types of resources. This is even more important in families where the education isn't there, the money isn't there, the language may not be there, right? Where you guys are in San Diego, I'm right here, so lots of Spanish speakers. Almost 70% of the families that we serve speak Spanish. And so making sure that the resources are accessible. And I feel like it almost seems like everyone has a little piece of the puzzle of a resource or even a list of resources that might be available to your child. But there's no... resource center that is saying hey we're going to have someone before we discharge you come from our behavior analysis team or from our resource center and talk to you about all the resources so we have behavior analytics services we have this that and we're going to call you back and make sure that you are able to tap into these resources because we know that they're urgent at this point for your child right there's there's no liaison it's bringing together all of the information in terms of what resources already exist to make sure that families I can't even imagine Imagine how hard it would be to just have to search the World Wide Web for what is available to your child in a community where you pay taxes.

SPEAKER_02 47:45

Which the regional center is supposed to do that. And they do a wonderful job, but there's still a lot of loopholes. There's still a lot of holes in that.

SPEAKER_01 47:55

Yeah, they also don't serve every family, right? So they have eligibility requirements. And so what if your child is not eligible for regional center services? But I mean, you know, they are, that removes every resource that regional center has. Also, we're looking at capacity. How many of these services can regional center even get out if they have a very lengthy, very grueling process to even add new providers to their service delivery line? So it's like the providers that are in place, there's also not very great resources. checks and balances for whether or not they're able to provide the services, whether or not the services are quality. They do a good job at surveying what services are needed, but then they limit who can provide those services. And so because they do that, the teams that are assigned to these kiddos, they're just over capacity too. So no one is really getting high quality anything because everyone's trying, as autism continues to to spiral and grow out of control. There just aren't enough providers to provide the services that are necessary. And the providers that do exist, my pastor actually said something really interesting. He was like, the providers exist, but y'all are closed on nights and weekends. And that's when the kids are getting in trouble.

SPEAKER_00 49:13

They're not in school.

SPEAKER_01 49:16

That's when they're at home with their parents getting into things, right? They're stealing on the weekend. They're sneaking out of the home after hours. You guys are closed. The behavior team is unavailable because you guys don't have any emergency response team. And I was like, wow, you're absolutely right. So these are service delivery lines that if we're smart, we can find the gaps. And from a business perspective, from an organizational management perspective, we can say well this is what's missing how can we create it right do we have emergency response teams because I cringe because I see behavioral providers say yeah this kid needs a higher level of service than what we can provide and I'm like yeah ethically we're supposed to do that the clinician doesn't feel that they're qualified but at the same time who's a better service provider than the behavior team and where are you referring him out to because there's no one else that can really do what we do but we get so afraid to do it because it requires us to step outside of that little box that I think aba providers want to stay inside of to be comfortable with what they learned in their master's program

SPEAKER_02 50:12

well that's what dr scott was talking about a couple of episodes about his kind of gripe with the bacb right about that we have to have that high level of competency but that really limits our ability and our scope because if we don't have the high level of competency we can't go out and work on things and if we're training under somebody who's done it that means we're just regurgitating the way that we've done that they've done it so that that was an interesting discussion that you kind of just alluded to as well that uh One of our previous guests brought up.

SPEAKER_04 50:41

Whoa. And this concludes part one of our conversation with the illustrious and ever articulate Porsche James. Please make sure you return for part two. In the meantime,

SPEAKER_00 50:52

always analyze responsibly.

SPEAKER_03 50:55

ABA on tap is recorded live and unfiltered. We're done for today. You don't have to go home, but you can't stay here. See you next time.