Beyond the Spectrum: Diverse Paths in Applied Behavior Analysis with Nicole Parks, Part I

ABA on Tap is proud to present Nicole Parks (Part 1 of 2):

Nicole Parks is a Board Certified Behavior Analyst with nearly two decades of experience across diverse settings, including forensic systems, mental health, and autism therapy. As the Chief Visionary Officer at Rooted Consultation, she champions the expansion of Applied Behavior Analysis beyond its traditional scope, focusing on subspecialties and innovative applications of behavioral science. Nicole is a passionate advocate for mentorship, ethical practice, and supporting BCBAs in building careers that align with their interests and expertise. She believes that ABA can make a significant impact in areas like addiction treatment, child welfare, and the justice system, and actively mentors future behavior analysts to push the field forward.

Along with Mike and Dan, Nicole explores the possibilities for BCBAs beyond the traditional focus on autism therapy. She shares insights into creating a fulfilling career in subspecialty areas of ABA, based on her experience in areas like forensic systems and mental health. Topics include:

• Breaking the Mold: Nicole's journey from forensic and mental health work, and what drew her back to non-traditional ABA practice.
• The Subspecialty Framework: A plan for diversifying your ABA practice, focusing on supervision, learning, and job creation.
• Funding vs. Fulfillment: The financial realities and potential for burnout in traditional ABA settings, and why many BCBAs may consider alternative paths.
• Real-World Scope: The importance of understanding your scope of competence and strategically expanding it to thrive in diverse roles.

This brew offers a wide array of flavors across  Applied Behavior Analysis palette, for both seasoned BCBAs looking to diversify their careers, and aspiring behavior analysts seeking inspiration for non-traditional paths. Sit back, sip deliberately and ALWAYS ANALYZE RESPONSIBLY. 

Transcript

SPEAKER_04: 0:10

Welcome to ABA OnTAC, where our goal is to find the best recipe to do the smoothest, coldest, and best-tasting ABA around. I'm Dan Lower with Mike Rubio, and join us on our journey as we look back into the ingredients to form the best concoction of ABA OnTAC. 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 responsively.

SPEAKER_03: 0:53

Alright, alright. And 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, how you doing?

SPEAKER_05: 1:06

I'm doing great. How you doing, Mike?

SPEAKER_03: 1:08

Doing good. We've been out of the lab for a little while, out of the uh reptile studio, and back with a banger with a really good guest.

SPEAKER_05: 1:16

We got Nicole Square today.

SPEAKER_03: 1:18

It's Nicole Day today. We're starting with Nicole Parks, uh, Chief Visionary Officer at Rooted, does all sorts of things outside of our uh soapbox, outside of our foundation with autism treatments. So we're really excited to uh spend some time with her today. So without further ado, Nicole Parks. Nicole, good good afternoon, and thank you so much for your time. How are you doing today?

SPEAKER_00: 1:48

I'm great.

SPEAKER_03: 1:50

We really appreciate our guest time on a weekend. We tend to record on Sundays, so we really appreciate you accommodating uh our recording schedule and joining us for today. We love to kick right in with the origin story, and uh, given our conversation prior to recording, we're in for quite an origin story here. And I think it's exciting for our listeners out there who are likely primarily in autism treatment to start considering how somebody else started and what else they're doing outside of that realm. So without further ado, tell us a little bit about how you got started. I guess a little bit about what you're doing currently, and then take us back to how it all got started and and uh brought you to the current.

SPEAKER_00: 2:31

Okay, well, uh currently I have a consultation company. My biggest focus right now is on supervision CEUs outside of ABA therapy. Um, and kind of like connecting on like a personal level, my my favorite specialties are forensic um ABA, clinical ABA. So those are my special niches. We'll talk about that like in a little bit.

SPEAKER_05: 2:58

Got my note-taking device here. So if you if I look down, I'm just taking notes. I'm not distracted.

SPEAKER_00: 3:02

Okay, no problem.

SPEAKER_05: 3:03

Please text.

SPEAKER_00: 3:04

Um, I know most people kind of do a highlight version of their backstory, but I'm gonna go deep because I think it's important for people to understand how I got to where I am today and kind of the skills I picked up along the way.

SPEAKER_03: 3:16

We have the time, please do.

SPEAKER_00: 3:18

Okay. So to start off, um, when I went off to college, my plan since middle school was I was gonna be an international business attorney. I pictured myself in a high-rise, rocking my baby, um, and signing a bunch of legal documents and making the big books. So I'm like a millennial. I grew up with 80s movies, working girl, baby boom. These were like my favorite movies, this idea of these like high-powered women executives that could like do anything. So that was my like thought. Like, I'm gonna be a mom and I'm just gonna rule the world. So that's what I went into college thinking. So I was minoring or I was majoring in international economics, I was minoring in Japanese. Um, first semester, Japanese is super hard because you have to learn it and three writing systems at the same time. Um, my first business class was a snooze. I hated it. So one semester in, I'm like, I gotta change. I know I've been wanting to do this since I was like 12 years old, but we're gonna regroup and think of something else. And so I'm like, what can I possibly do? And I remembered I took a psych class in high school and everyone always liked to come and talk to me about stuff. I think people are really weird and interesting. So I'm like, I'm gonna go to psychology. Um, and my mom immediately, who was like the most supportive mother ever, this is the first time she ever gave me crap in my life, and she says, if you switch to a psychology major, you're gonna be working in a restaurant or a clothing store for the rest of your life. So she just saw me like completely sinking like every dream I have into nothing. So I um set out to prove her wrong, and I like to rub in her face all the time that I graduated with my bachelor's in 2003, and I've never worked a day outside of ABA. Um, so that psychology degree has gone to good use. I've never worked in a clothing store, I've never been a server at a restaurant.

SPEAKER_05: 5:04

Oh man.

SPEAKER_00: 5:05

Um it's like a right of time.

unknown: 5:08

Yeah.

SPEAKER_03: 5:08

You had something to prove. Good, good for you. Good for you.

SPEAKER_00: 5:11

Exactly. Um, so my first class in psychology was intro to ABA with Dr. Jesse Dallery at the University of Florida. And it was like maybe his first or second semester teaching. And he's a clinical psychologist. And the way that he talked about everything was this is this cool science you can use to treat people with phobias, addiction, all these other things. And I'm like, I gotta, I gotta get into this. I this makes so much sense. It works for my logical brain. Um, I have to learn everything I possibly can. And he dangled a little carrot in that first class, which was, I will let certain undergraduates into my graduate level seminar class when they're seniors if they've done enough work. And it was like a very loose, like operational definition. He wasn't tight on like what that meant.

SPEAKER_01: 5:56

Okay.

SPEAKER_00: 5:56

But for me, I was like, I'm gonna do everything I can. I'm gonna take every AVA class I could possibly take, and I'm gonna make it into that seminar level class. And I did. So um, another thing achieved, it was really awesome to be a senior and be taking the first class that all the graduate students were taking. Um, but through the course of that, I ended up taking um my lab work with Dr. Brian Awada and working as a research assistant in some of his different lab projects. He had three different ones going on at the time, one at a school, um, one at like a uh like a learning center kind of for adults with developmental disabilities, and one that was a severe self-injury clinic that was only on Fridays. Normally, undergrads were not allowed to work there, but they were short staffed needing research assistance one day, and I volunteered. And from then on, I got to go to the Promised Land that no one else was left to go to as an undergrad.

SPEAKER_03: 6:47

Nice, wow.

SPEAKER_00: 6:48

Um yeah, so a lot of this, a lot of my story, I think, is like taking advantage of opportunities that presented themselves to me. Um, so after I graduated, I took six months and I continued to work as a volunteer with Dr. Awada's labs because I heard that he was inheriting a project to work with people with Prader Willie syndrome. And he was gonna hire a couple people that had been research assistants for him previously. And I had my hat or my name in the hat. And um, so I kind of just kept with him for six months, and then I was one of the only, there's two people that were hired full-time, and I was one of those people. Wow. So my first experience, thank you. So my first experience outside of undergrad was working with Proter Willie population, which not a lot of people have worked with. Um, we're talking like very severe self-injury, very severe aggression, um, just things you don't think about treating. Um, I don't know if you guys are familiar with that population at all.

SPEAKER_05: 7:43

I actually had a client that I worked with in the school. It's actually one that I reference a lot in um my nine to five job when I talk about stories. But yeah, I got a client that had Prado Rilly syndrome, had no idea what it was, so had to do some research because Monday I was gonna start working with a Proterwilly client. Yep. Gotta hide the food.

unknown: 8:00

Yeah.

SPEAKER_00: 8:01

Yeah. So they're um it's a genetic disorder and they are constantly hungry. They don't feel full, so they're always like seeking food. Um, and so we worked with a geneticist that actually um did work with them, set diets for them, and part of our thing was basically having them on token economies to be able to earn extra calories by engaging in exercise and things like that. And we kind of worked with them at the day program and at their group homes. Um, and so that was my first experience. And during that time, I was lucky enough that because I took all those classes, um, in undergrad, I actually qualified to sit for the BC ABA exam. So history lesson for newbies, it used to be the BC Big A BA. So you are an assistant behavior or associate behavior analyst, not an assistant behavior analyst. Um so I got my hours while I worked at the Prader Willie program and was able to sit for that exam. So I got my BC ADA in 2004. And then I left that program and actually went to work for the state of Florida working with the psychologist over the whole area, which was about, I think we were over six or seven counties, overseeing behavior analysis services for the Medicaid waiver program in Gainesville. Um, so I was like 23, and all of a sudden now I have to review the behavior plans of people that have been doing this for years and years and years and make them think that I know what I'm talking about. Wow and have some respect for me.

SPEAKER_05: 9:21

In Florida, I hear there's a lot of funny stuff in the Florida streets.

SPEAKER_00: 9:26

Well, the thing is, what's great about Florida is because the board originated there, we had Florida certified uh analysts. People might not know about that. So at this point, they were still grandfathered in, they still had some time before they had to become a BCDA. Um so we had some of those that were providing services, and then we had people that were actually V CDAs. Um, but essentially, if you wanted to deliver services for the Medicaid waiver program, you had to come to the local review committee and myself and the psychologist I worked with, we had to approve as a committee all of your plans. Wow. So we had to give you feedback and say this does or doesn't meet the statutes. Florida has very strict statutes about um uh delivering ABA services, which I thought every state was gonna have. I will tell you in a minute that that's not how that was. Um, but that's what I thought every state was. So I was very, very um educated on how to read law, like very early on. Like, is this a legal thing? Like, can we do this? Um, are we following all the rules? Um, I also got to go back in and audit the program that I used to work at for the Prader Really um program because they were receiving state dollars as an attempts of behavior program, and part of my job was to evaluate programs and see if they still qualified to receive that money. Um interesting. And it was really interesting to go back and audit the place where I used to work.

SPEAKER_03: 10:41

You did you know, did you know too much uh in a sense? Or uh that's a good idea. I learned a lot of things.

SPEAKER_00: 10:47

I will just I will say it was eye-opening. Interesting.

SPEAKER_03: 10:49

So you weren't aware when you were there, and then now from that other perspective. Wow. Okay, cool, cool, cool.

SPEAKER_00: 10:56

So very early on in my career, I advocated to everyone that would listen do not blindly believe any person that is responsible for you as a supervisor, that they have your best interests at heart. Uh, you need to know what you're signing. And this like went on later on, working in autism therapy and stuff like that. And like if you're a BCBA and you're interested in insurance contracts, I don't care who helped you do that. You better read those contracts because you're responsible for everything that you agree to, and you cannot just trust other people to do certain things. Um, so my eyes were open like very early on about that kind of stuff. So that was part of my job there. Also, I needed to go over um anytime there was like any crisis that happened in any kind of group home, any incident reports. I was in charge of the committee that reviewed all of those, and we had to decide what are we gonna do to make sure these things are not happening again. Um, up to and including deaths that happened in group homes, which unfortunately did happen a couple times while I was working there. Um, and then the last, you know, kind of like big thing I had to do that was very eye-opening for me is that um as it is currently, waiver programs have years and years and years wait lists. And this like these are dollars that families really, really need to have access to. Um, these are adults, you know, so these are not kids anymore. Um and so in the whole state of Florida, we had 10 spots that were open for emergencies every single month. And part of my job was to call these families and see what was going on with them and decide whether or not they got pushed to the state office um to get considered for emergency dollars and see if we could get them as one of those ones that are approved. So again, very early in my career, I'm getting all kinds of lessons about stuff, all kinds of really important lessons that I think not a lot of people have that kind of experience when they come like straight out of their bachelor's program.

SPEAKER_03: 13:23

That that is true. I think that's uh just the administrative piece. I think I mean for me, I I I shy away from it uh because it takes my focus away from what I really want to do, which is be with the clients uh and doing the direct work. So I do think what you're pitching is is uh something very unique and that uh it's it's been eye-opening for me uh to be uh a new business owner, yet again in the current climate, and have to strike that balance of at least for me, knowing just enough of the parameters around everything I'm doing so that I understand it well, um, but also staying away from it enough that excuse me, um, at least for me, it doesn't detract from my focus. So I know you're probably gonna get into that, how you've struck that balance. You know a lot of information now. Now you're going back to programs that you've been in before, you're seeing it from a different perspective. Where does that leave you?

SPEAKER_00: 14:17

Well, I'm, you know, infinitely grateful. And I'm gonna I'm gonna carry on my, I'm gonna carry on the journey here because the next place I go to work is with adults who are duly diagnosed with either substance abuse issues and developmental disabilities or developmental disabilities and mental health diagnoses. They're living in supported, uh like a supported living environment. It's basically a converted motel that is now individual apartments. And I have one or two clients that are actually um on probation. So I have some forensic involvement too. And my job is to work the B the ABA angle while they're also getting mental health therapy on site. Um and we have to kind of work together. So I have to learn to navigate with mental health services. What's my job? What's your job? How are we gonna kind of make all those things things work together? Um, so that's my first like dabble into mental health and substance abuse.

SPEAKER_05: 15:10

Can you speak to when you say forensic? Does that just are you just saying that in terms of like uh interaction with the law? Or that was one of my notes I have here.

SPEAKER_00: 15:18

Yeah, so forensic essentially just means the law is involved in some way, has something to do with the criminal justice system. Okay. Um so uh yeah. And unfortunately, one of the people that was involved with the law, this was again, I think, an eye-opening thing for me, is that he um was in a group home and engaged in some sexual activity with another consumer at that group home who actually was an adult, but um their parents had custody over them. So they were not actually legally able to consent to sexual activity. So that person was then on a sex offender registry. Yikes. Um so again, learning things like, okay, these are things that happen. So like every person I've ever met since then, I'm like, you need to know, like, just because they're an adult doesn't mean that they have the legal ability to consent to certain things. We're gonna have to be talking about, you know, adult things with adult people. And I think that's something that isn't thought about a lot when you're working with kids only.

SPEAKER_03: 16:13

Right. And that's so that's a parameter of conservatorship. I guess uh I I would have never thought of that. And and how do you know that until you know that? And then you're like, ah, let me tell you about this because you may not encounter. Uh division.

SPEAKER_00: 16:28

And a lot of parents don't know that if they don't seek that, as soon as their child becomes 18, they have no like legal rights over it anymore. Right. And so if you're not prepared for that and they're not in the right headspace uh to be consenting to everything, and you're not prepared for that, a lot of things, hairy things can happen at 18.

SPEAKER_05: 16:44

Which is an interesting question for somebody to prospectively ask, are you conserved? That's like a interesting question when you're interacting with somebody, right? But that person would theoretically need to know that answer because if they are conserved, they can't give consent. So now it's a whole different, whole different ball game, right?

SPEAKER_02: 17:01

Exactly.

SPEAKER_03: 17:02

That's very interesting in terms of uh that interaction, right? So that that's that's fascinating. I I'm not even sure where to go with that. You've you've left us a lot to unpack from starting with Proder Willie. You but I'm gonna start with uh you mentioned developmentally disabled individuals with addiction uh profiles. Talk about that a little bit. That's probably not something uh that people come across often. Uh what tell us a little bit more about that.

SPEAKER_00: 17:32

Yeah, I mean, so I can think of one of them in particular who was he was an alcoholic. Um, so part of his program was trying to abstain from alcohol because when he was drinking, uh he made bad decisions. And he was skirting getting involved with the law and luckily wasn't. Um so it was like again, working within that you're an adult. You are free to make your own choices, but maybe there's some limitations to what you're allowed to do. And it's again like these fine lines of this is his apartment. Okay, they're in supported living. This is his apartment. He gets money that goes into this program to pay for this apartment. However, the staff at the apartment and this program are ultimately responsible for him. So it's this weird balance of like, how do we let you make your own decisions? How do we try and encourage you to make better decisions? Will you even agree to go to mental health counseling? Like he was one that didn't really like to participate in treatment very much, so he didn't really go to mental health counseling too much. Um, and so sometimes he'd be on a great path, and sometimes you'd see him walking up to his apartment with a six-pack of beer, and you're like, all right, this is not gonna be a fun night, probably.

SPEAKER_05: 18:38

That's interesting. That sounds like straight off a BCBA, because I helped a lot of people study for the BCBA when I was um at my previous company. That sounds straight off like a BCBA ethics question that we would have had to walk through like some of those scenarios you just talked about.

SPEAKER_03: 18:52

Um you're talking a little bit about, I mean, I guess the the best the best phrase I can think of is this collaborative treatment across these different levels uh that means something different in what you're describing. And you alluded to that earlier with, say, the mental health professional or counselor, and you know, what's your role or what's my role? Um in that situation, in terms of you know, putting the uh can of beer to your mouth as a behavior versus this notion, and I don't mean to overgeneralize, but this notion that that's a coping mechanism, how does that balance out? How did you sort that out with those other individuals? Because that's a there's a lot of crossover there, crossover there. There's a lot of opportunity for um you know people to want to toot their own horn a little more loudly. That that can be challenging, especially with somebody now with a developmental disability who's you know maybe drunkenly aggressive. That's a lot, that's a lot to manage.

SPEAKER_00: 19:43

Yeah, and I'm gonna be honest with you. I mean, at the time, it's one of those like I wish I knew then what I know now kind of situations. At the time, again, I'm like 25 years old, I have a bachelor's degree. Okay. I'm not a master's level clinician at this point, but I am in charge of this program because that was totally legal to do then, right? Like back then, when you had a big A, you had the same rights uh as a B C B A. It's just that you got paid less.

SPEAKER_05: 20:09

That's the only difference. I like that. The big A.

SPEAKER_00: 20:12

Yeah, the Big A, you could do everything B C BA could do, you just got paid less.

SPEAKER_01: 20:16

Sure.

SPEAKER_00: 20:16

Um, so I left that job and went into what I consider to be like really a transitional job for me, which is working at a state psychiatric hospital in Georgia. Um, so there we've got a short term unit, which is basically like your 72 hour holds, you know, you've threatened to kill yourself, you've done something, whatever, you're having a schizophrenic break, whatever the case may be, you're on the Short-term unit, the long-term adult mental health unit, which is basically like you have no place to live in the community, essentially. It's just like a storage unit for people that don't have community access. And then we have two forensic units. So you're on those units because you're either not guilty by reason of insanity or you can't stand trial. Um, you're not competent to stand trial. And so uh the state of Georgia, all the hospital systems had gone through a settlement with the Department of Justice because a lot of bad happenings had been going on at these hospitals, people being abused, people dying essentially is what set that whole thing off. And so the hospital system said you need to bring positive behavior supports into the hospital system and some other things. There were some other changes and stuff that needed to happen, but that's how I ended up there because they created these behavior specialist positions that would sit on the treatment teams and basically kind of be like the partner to the psychologist on the treatment team. I was the only one that was actually a behavior analyst. Everyone else basically had a master's degree, maybe in like counseling or something like that. And at the time, I had finished my master's degree and was pursuing my fifth extra 500 hours I needed to get to become a BCBA because they changed the big A to a little A and said you have to start working under a BCBA, and that's what kicked me into getting my master's degree. Um, and I got my master's in counseling with a focus in applied behavior analysis. So I had a ton of counseling classes, um, abnormal psychology, all kinds of things like that. So I understood all those kinds of things. Um, and so my psychologist I was paired with was amazing and was very open to the idea of behavior analysis and was a huge advocate for me and the treatment plans and stuff I wanted to do. Um, because he really got it and he did a really great job of using his degree to push my ideas and then give me all the credit for them. So I am so thankful that that is who I worked with. Um, but this was a true collaborative team experience because essentially what happened is these individuals would come into their treatment team, which was the psychiatrist was the head of the treatment team. So every unit had a psychiatrist, psychologist, behavior specialist, social worker, uh, someone from nursing, someone from just like direct care staff, and the individual. And we all have to come up with a treatment plan for them together. And so one of the big things I got promoted into was rolling out a token economy for the entire hospital system that would encourage people to participate in their therapy, essentially. So I was the director of that program, and that was like training all the staff, teaching everybody how to run the program, figuring out how we're gonna differentiate like the point cards, how are we gonna make sure that they're not forging point cards, what are we gonna put in the store, which we had to get approved. I had to chair a committee of everybody from risk management, nursing, the speech therapist that made sure it wasn't choking hazard. Like every single person had to approve what was going into the store. And we have to make sure that they're priced appropriately, people are actually gonna want them. And I'll tell you, in a restrictive environment like that, the thing that was the big ticket item was uncrustibles. Everyone really wanted to use their points for uncrustibles. Um, but the way this program worked is that they could earn 100 points a day. 50 of those points had to be assigned by their treatment team to make sure it was things that the treatment team thought they needed to work on, and 50 points they could assign for themselves. So if it was something they knew they were already gonna do, they usually put their 50 points in that area. Um each unit had a different colored card. They had to be signed off on a red pen. Only staff members could have the red pen. So we made sure there was like no forgeries. Um, and essentially they got to go to the token store once a week, come off the unit. Um, some people actually like legally had to stay on the unit, and so they would get deliveries, but they could come off the unit, come to the store, they could get one food item, one drink item, and then they could use their points for special orders, special hygiene items. And eventually we started hosting activities that were themed that they could buy tickets to. Wow. And this was encouraging them to take their medication, clean their bedroom, take showers, participate in therapy. They got certain points for all those different things. Um, and the staff at the hospital were pretty skeptical at first, especially the psychiatrists. Um, but one of the individuals that had been on the unit for oh gosh, 15 plus years and never participated in a thing ever. He initially didn't want to know part of this. Um, but he started seeing all these people with these papers walking around, getting stuff. And he eventually decided to participate. And then he actually ended up coming to one of our events, and everyone was just shook because this man had never participated in a thing. Nothing they had ever tried had ever worked on him. Um, and it was really awesome to see how like successful that program was um and how much everybody loved it. But it was like a battle to get that thing going, to be fighting with everyone. Plus, I rolled that thing out at eight months pregnant, so I was like a mess.

SPEAKER_02: 25:25

Wow.

SPEAKER_00: 25:26

I had two babies, I said I had two babies at the same time. And that baby, and I had my baby, my baby baby.

SPEAKER_03: 25:32

So much to remember during pregnancy. I I know pregnancy brain can be uh a challenge. I I don't know personally, but I've heard.

SPEAKER_00: 25:40

Um yeah, plus it was it's a 24-hour hospital, so I had to do to train all the staff, I had to catch people that were on overnight shifts and whatever. So I think we ended up doing like 12 trainings in a week.

SPEAKER_03: 25:52

Uh if you can talk a little bit more about those particular challenges, you must you must have had to adjust that token economy uh continually at first, gradually over time, uh things that people were missing, things that just didn't make sense. I don't know if anything comes to mind in that experience, the little particularities that you had to manage, or that maybe those aha moments for some people that were resistant at first uh that that were probably pretty gratifying because you were fighting an uphill battle in many ways here.

SPEAKER_00: 26:20

Yeah, I mean, I think I love token economies so much, and I think people don't understand how complex they are.

SPEAKER_03: 26:27

That's a great idea.

SPEAKER_00: 26:28

Everyone thinks token economy, they think token bored. They think I'm gonna turn over a couple tokens.

SPEAKER_03: 26:33

I'll I'll even make it worse. They think star chart. And and I'm not, it's not that it's not a star chart, but you're right. It's so much more. So yeah, tell us a little bit about that.

SPEAKER_00: 26:40

Yeah. So like token economies are incredibly complex. Like, what is gonna like how much what is the response effort for getting the points? How many points are available? What can you like trade in for those points? And then when you're talking about on a group scale like this, it's like, is it something they're gonna want, but they can actually have? And we have a budget. So can we afford to put these things in there? Um, like so many things you have to think about. It's like trying to, you know, get that through everyone. Can they roll over points? How many points can they roll over? Like all these different things. So it's like the restriction on the food, one food, one drink, that was from the psychiatrists because they didn't want them, they're all on specialized diets. And since they're under the care of the psychiatrist as a medical doctor, they're like, I don't want to be responsible for that. So this is the limit we're gonna put in it. Um, if they were diabetic, they could only get diet sodas. That was a restriction put on them by the psychiatrist. And of course, we're saying they're going, like, we can't tell people what their reinforcers are. Like, we need it to be something they actually want. And we had to fight so that like they could get real food and not sugar-free candy and stuff. I mean, like everything was like a balance and a negotiation of like they have to actually want it. We can't tell people what they like, and it's a restricted environment, so that worked in our benefit a little bit, but also it's like, I mean, you would be surprised sitting at these meetings and being like, How about this soap? Like, I have to show you the exact soap. Well, how heavy is it? Well, could they use it as a projectile? Well, could they eat it? Could they just do everything?

SPEAKER_03: 28:02

Yes, yes, and yes. So you did these preference assessments, if you will, and then they would go get vetoed and they would get, you know, inked up, and then you'd have to go back to the consumer, so to speak, and and reassess, or how did that look?

SPEAKER_00: 28:18

Yeah, so basically, yeah, we'd have to go back and kind of figure out what ended up making it a lot easier was that we could take special requests. And once we figured out what the point value could be versus the dollar amount of something would cost, and people, some of them did were okay with saving and having that delayed reinforcement because they like really wanted a hoodie or they really wanted like whatever, not a hoodie with strings, of course, but you know, a hoodie, maybe zip up or whatever. Um, that made it a lot easier because we could be very specific to their preferences. And as long as like the group okayed it, we were good to go. So that helped a lot. Um, but again, restrictive environment. So those uncrustables were pretty popular. I think there's plenty of people in there. If you ask them how much you love uncrustables, they would be like, not that much. But when they see everyone else eating them and it's better than the food they're getting on the unit, they're like, actually, uncrustables are pretty banging. Kind of like uncrustibles.

SPEAKER_05: 29:10

So they could only trade in their stuff. You said once a week, they could go to the store and trade in their stuff. Did you find that they hit ratio strain pretty quick there? Like they have to, especially in the beginning, trust they have to do work for six days in the foresight that the seventh day it'll pay off. Did you have a lot of people that were just like, screw this? Um that's ratio strain.

SPEAKER_00: 29:29

Yeah, we had some that were just like, nah, I don't think I really want to participate. And what we would do is if they were doing the stuff anyways, we'd be like, let me sign your card. You you came here anyways. So maybe it's not like we didn't need the extra reinforcer to get them to do the activity, but we're like, let me at least show you what you've earned.

SPEAKER_01: 29:45

Okay.

SPEAKER_00: 29:46

And then again, you have it's just like with tech, right? You know, you have early adopters, you have like the middle people, you know, whatever. Our early adopters that were down were coming back to the unit and be like, guys, that was pretty cool. Like, we actually do get food. It was actually really cool. And even just being off the unit from not like therapy, being able to just like sit at the tables and chat with each other and have a soda, it felt like normal, a little piece of normal or whatever. Um, so yeah, they go back and tell the tale, and then people are like, Well, actually, okay, maybe, maybe there's something to this. Maybe I can, you know.

SPEAKER_03: 30:18

That that social part maybe not an aspect of reinforcement that you envisioned at the beginning. Is that fair to say? So the idea that I'm not gonna buy into the encrustable, but somehow now having that encrustable along with two other people raises the reinforcement value. That's that's kind of a cool uh happenstance discovery, maybe that maybe you didn't expect. And it's like, wow, look, we didn't expect this, or that gentleman showing up to the event where he had otherwise been withdrawn. Uh, that's a really cool collateral effect.

SPEAKER_00: 30:45

Yeah, that's why we ultimately ended up having activities that they could, again, they had to save points. It was like 500 points to you know get that and they're only getting, you know, 100 points a day or what maybe it was a thousand. I don't know. Can't tell you right now, it's been so many years. Um, but we also had like themed food that went along with the event because we knew food is like gonna get them there. So they were down with the themed food, and then that got them again coming out socializing, and we realized that that social aspect of it was so reinforcing. And so they really looked forward to having these theme parties every month, and the staff really liked it. I think the staff got to see a different like version of these individuals. Um, so overall, there was like so many gains that we weren't even expecting that happened.

SPEAKER_05: 31:26

So awesome. Did you ever run into so we our first client that Mike and I had, we had a token system where he would come, he basically went to school with Mike and I for six hours a day or whatever, and his biggest reinforcer was his video game. So we had a token economy um for him to earn that. Um, but there would be times where he basically hit a point throughout his day where he would not be able to earn enough tokens to get his video games. Um, and a lot of times he would realize it, and then it's like, okay, we would have some smaller reinforcers to try to get him through, but sometimes it was like, nope, that's there's either going to be a meltdown or he's not gonna do anything for the rest of the day because he's realized that the backup reinforcer isn't isn't available to him anymore. So I asked that to you. Did you ever run into issues with any of um, I don't know whether it's clients, residents, person served, whatever the individuals were there at your facilities, um, realizing that at trade-in time, maybe let's say trade-in time was on Sunday, by Wednesday, they weren't gonna have enough points. So they were just like bought out of the system for that week.

SPEAKER_00: 32:33

Um, you know, I mean, there were so many people we were monitoring. I'm sure that that probably it might have happened, not to the extent that it made a huge like impact because we would have heard about that. There's some huge behavioral outburst. Um, but I'm sure that that possibly did happen. This reminds me a lot of like DROs. So I think again, like people think DROs are super simple. They're not, right? If you don't have a reset on a DRO, when someone's out early, it's like game on for the rest of the day, right? Because they're just like, well, I screwed that up.

SPEAKER_01: 33:04

What am I looking for?

SPEAKER_00: 33:05

I might as well have at it for the rest of the day. What's my motivation? Yeah. Um, so it's kind of the same thing, you know, and you're gonna have misses. I mean, there's gonna be misses. There's gonna be certain people that it wasn't as effective for, or they had that issue like you're talking about, maybe they like realized, oh, I didn't go to therapy or whatever. It was somewhat controlled by the fact that they could allocate 50 of their points and we encouraged them, like we told them put those 50 points where you already know you're doing something or where something's very easy for you. So if you're the type of guy that like loves to shower every day, put your 50 points in shower. We really wanted them to contact that contingency. So we're like encouraging them. This is not a trick. Put them where you think you're gonna get them easily, and we have the other 50, and we're gonna put those in a place where we think you should be, you know, trying. And I still we would encourage, you know, again, psychiatrists might be like, put it in the hardest thing, put those 50 points in the hardest thing that they're never doing. And so I might be like, eh, or how about we put them in something that like they might do? You know, let's start small, the same way that we would write any other kind of program, right? We're not gonna shoot for the moon if baseline is here. Of course. Um, and some psychiatrists were down with that, and some were like, Nope, put the 50 points where I tell you to put them, and you're like, all right, dude. Okay.

SPEAKER_05: 34:18

Well, yeah, I mean, with any differential reinforcement program, right? You'd have to contact the reinforcer and then build up, otherwise, it's not gonna be successful, then you're just back to zero.

SPEAKER_03: 34:26

And that can be hard to teach, right? The idea that somebody doesn't have a taste and they don't understand what the reinforcement might be, and that can that can be interesting. Did you find any tricks in trying to disseminate that information uh across the staff? The idea that uh, I don't know, cut somebody some slack sometimes, give them a chance, get them to the reinforcer versus be so stringent as to how you apply the system. That that can be difficult. Uh there's uh maybe even night shifts you might have noticed. I don't know. There's a level of authoritarianism that can get the better of any of us, and then suddenly we're missing that nuance. We're missing that point, and well, the system doesn't work. Well, the learner doesn't know what they're they have no idea that that that this is what's available to them.

SPEAKER_00: 35:10

Yeah, I mean the thing is like we knew who our real hard asses were, you know. I don't know if that's gonna get you the explicit.

SPEAKER_05: 35:16

No, that's perfect. It will hard asses on the staff side or on the patient side. Oh yeah.

SPEAKER_00: 35:21

On the staff side, on the staff side. Um so we knew, you know, like there's certain psychiatrists that they were not gonna budge and they were gonna throw their weight around. Um, but we also knew who the other power players are, right? The charge nurse on the unit is another power player. So if I can get win over the charge nurse and maybe win over the psychologist on the unit, so I've got a couple people on the treatment team on my side, then we could kind of like try to outnumber the psychiatrist.

SPEAKER_01: 35:49

Oh man.

SPEAKER_00: 35:49

Or if they have more, if they have more sway, right? Because if you've got those degrees, you're gonna have more sway. So if they have more sway, maybe they can kind of talk them into it instead of me.

SPEAKER_03: 36:00

Um so now into your unofficial introduction into OBM. Is that is that the segue there? Or into politics air politics. Where are we going next, Nicole?

SPEAKER_00: 36:09

Yeah, basically. So yeah, so I mean, we just knew whose side to get on, you know, who's the good side to get on. And you know, remember there's other um treatment plans and things going on in these units where we have smaller ways that we could show staff like ABA works. Like, let me show you how this works.

SPEAKER_05: 36:25

So let me ask you a question on that. Um, it makes me think about uh recent guests that we had on that went and talked to um some sheriffs and said it was um interesting. So on the forensic side of things, and I guess you could almost call it the correction side of things, a lot of it's built around punishment, right? Like it's just removal of things instead of, like you said, positive behavioral supports, uh what we use for behavioral management is we take more stuff away until we're in solitary confinement, and that's that's kind of what it is. Did you run into a lot of issues with kind of traditional schools of thought of the way you respond to these things is you take things away, and you might be coming in saying, no, let's work on giving people things, and the institutional thought of these organizations are no, you take things away.

SPEAKER_00: 37:09

Yeah, I think um so this is one thing, I guess, that's like very ingrained in the culture. When you have behavior issues that are heightened in like can't be redirected, you know, right away. What happens to you in a psychiatric hospital is the charge comes in and you get a shot. That's what happens.

SPEAKER_05: 37:29

Okay.

SPEAKER_00: 37:30

That they call they call the psychiatrist, they tell them to uh give a prescription and you get a shot, a Vataban or whatever. And that's what's gonna happen to you.

SPEAKER_05: 37:39

Okay.

SPEAKER_00: 37:40

Like very quickly. They put up with no nonsense. So part of this is trying to get them to understand like the function of behavior, and me at the same time trying to be like, okay, well, I'm learning more about, you know, borderline personality disorder, schizophrenia, whatever. So what of these things are even behavior that I can influence or not, you know? So it's like learning a lot. I mean, I learned a ton from the psychologist because I'd be like, show me your testing, show me what you're thinking, show me, you know, like we're collaborating a lot. And one of the cases that really stands out for me is we had an individual who um was diagnosed with bipolar disorder, borderline personality disorder, she would engage in really severe headbanging to the point where she was bleeding. And it was because she was drug seeking. We knew this, I knew this because looking at her history and psychologist and I working together to look at the ABCs of this behavior, and that ultimately she was not allowed to have, she didn't have access to other drugs she would have on the street. And so that shot of Atavan or whatever, benzodiazepines are highly addictive. And so she wants that shot. So we were able to convince the psychiatrist to let us run a behavior plan, put the shot on extinction, we're not doing that anymore. And instead, we knew she liked very much valued my attention and the attention of the psychologist. And so if she was not engaging in some of these precursor behaviors, she got special time with us on the unit. So we're running these two things at the same time. And it she did great. We saw a huge drop, huge drop. Um, everything was going really, really well. And then she was having a little bit of a hard time. It had been weeks and weeks, months, I think, even she was having a hard time on the unit. Psychiatrist lived like three hours away, so he got out of there real early on Fridays. Um, and she's having a hard time on the unit, and the psychologist and I are not immediately available to get over there to see her. And we find out that they called the psychiatrist to get the shot.

SPEAKER_03: 39:38

And boom.

SPEAKER_05: 39:39

I think in California that's called Reast. I could be wrong. So are you familiar with Proact? Have you heard of Project before? Have you heard of uh CPI? Have you heard of CPI? Yes, it's it's a competitor to that. I think it's better. Uh, you might want to uh look into it. It's um a company I work for, we do crisis management um and de-escalation stuff like CPI. But we work with a lot of group homes, a lot of hospitals, stuff like that. Um and yeah, I think it's called being reased in California. I'm sorry if I'm butchering that. Uh, but basically that forced medication um thing saying that um somebody has like a judge or whoever, uh maybe it's a doctor. I think a judge has to sign off that the person has the authority to do that, basically give medication against somebody's will. Um and so how effective did you find that that was those out of hand shots or things like that? Did you find that it w it worked well and quickly, or did you find that it didn't?

SPEAKER_00: 40:38

I mean, yeah, it worked well. That's why it was hard to keep with. Right. Because we're getting immediate, immediate relief for the staff. Okay. Because they're like, listen, this is a problem. Everyone there was safety care trained. That was their that was our crisis management in terms of things. Safety care is done those things, we've done those things and they're not working. And I have a whole unit of people to take care of. And the shot is real quick. Um then this person is sedated and I'm good and we can move on with something else. So it's really hard to ask them to like tolerate higher levels of behavior to give it a chance for behavior interventions to work.

SPEAKER_05: 41:15

So can you speak to that? Because I think in ABA, you know, we work a lot of times in home with kids and we focus so much on the kids' behavior, but it's not really the kids' behavior, it's the parents' behavior that we really need to focus on. And if let's say yelling or spanking the kid is working for the parent, then we might have a better strategy. But if it's working for the parent, then why are they going to change something that works? So if this out of band shot's working for your staff, how did you get through and get them to change it?

SPEAKER_00: 41:41

Honestly, what worked the best is we came on the unit and we took the brunt of that behavior. And we showed them we're in it, we're in it with you. We believe in the soul, like, because if you're telling them those directions from off the unit, okay, they don't care what you have to say, right? They're the ones dealing with this. But if you're on the unit and you're actively like trying to mitigate what's going on, and you're like, I'm gonna step in, I'm gonna get involved, I'm gonna try. If I have if I get hit or whatever, then so be it. I'm gonna like power through that or whatever. Um, then they would start, you've got you've earned some respect from them. And they're like, okay, so they mean business. They must really believe in this if they're willing to come in here and get hit to do something different. And that kind of like gets them thinking, like, all right, maybe we'll give you a little bit of a chance to like work some stuff out, especially if you're willing to come here and manage the situation and I don't have to, then I'm basically getting the same thing in the end, anyways.

SPEAKER_05: 42:33

So especially while pregnant. You did a lot of that while you were pregnant as well.

SPEAKER_00: 42:37

I didn't go on the I didn't go on the unit when I got super pregnant, um, but my psychologist would if he would go on the unit.

SPEAKER_04: 42:43

Good for you. Yeah.

SPEAKER_03: 42:44

That's uh that's really fascinating. That so did you find that you were able to model then some of those uh more de-escalating approaches or interactions? Because if these people were coming quick with the Atavan, I mean that's oh, you're acting up. That can that can get really authoritarian really quick. How what was that like? Uh, you know, what kind of resistance did you face? Or did you find it pretty easy that once you were able to roll up your sleeves and say, look, I'm here too, that people followed suit.

SPEAKER_00: 43:13

Yeah, I mean, I think, you know, we got again, like we had those like early adopters that we had really good relationships with as far as like the staff on the unit, and they would were willing to give us a chance because they liked us as people, because we respected them as people. Um, and so we kind of did that pairing relationship with them first, making sure that they trusted us that if we said we're gonna show up, we're gonna show up, and that would become interested and we'd be like, you know, watch how we interact with this person. And then they would go and they tell a friend and they tell a friend, and eventually they start spreading, like, oh, these people actually kind of know what they're talking about. So give them a chance. So then, like, the people that were a little less likely to listen to us start listening to the people that they do respect, which might not be us, but we're connected to those people.

SPEAKER_03: 43:55

And that's a whole different um, I guess, in terms we especially early on with autism treatment, I think that behavior analysts you know didn't have a very good reputation of being collaborative. Based maybe in that context, you were coming into a table where uh maybe you didn't have that uh privilege of of being a little bit arrogant as a behavior analyst. You were sort of coming in as a as a newbie, and I think that you know as the medical services table, for example, we're we're still pretty new to that.

SPEAKER_05: 44:24

Um behavior analyst, it's not arrogant.

SPEAKER_03: 44:27

Right. Maybe we've we've hit a point of humility, but that's I don't know if you can speak to that. That's interesting. You you were always coming in having to to to make a pitch to be like, hey, I let's try this, and probably hitting a lot of resistance. So this idea that that you could come in with this stereotypical behavior analytic arrogance, that that wasn't uh something you had there.

SPEAKER_00: 44:48

No. Um, and I never and I never had because remember, you know, like I start off like in the big leagues, in my opinion, from like very young.

SPEAKER_01: 44:56

Yeah.

SPEAKER_00: 44:56

And I need buy-in. I need people to believe me, um, and I need people to respect me. And in order to do that, I need to understand where they're coming from. I need to understand their perspective, and I need to slowly show them that I can be um a partner with them in what we're trying to do. And I might have some ideas that can make their life easier. And that is still what I tell people I mentor today that are trying to eat if they're working in autism therapy or they're trying to break into something else, is I say you're about to go into a system that you don't understand. And there's people that have been playing in that system a lot longer than you have. So your first role is to go in and just observe and ask questions. Tell me about your pain points. What are you trying to accomplish? What is getting in your way? What are the barriers? And you're just gonna collect information. That's what we do. We observe, we're gonna collect some data, we're gonna get some information before we just jump in there and be like, well, I know that we should be doing XYZ and I know better than you because they're gonna kick you out of there real quick.

SPEAKER_05: 45:53

Yeah. I mean, we're working on a uh uh training, I guess would be the statement for BCBAs uh going into the schools because historically that's been a big pain point. Um, Mike's wife um works in the schools, my domestic partner, she works in the schools. Um, and there's been a lot of conflict between, you know, historically, between I think is maybe getting better now, but like you said, BCBA is going into the schools, and we might have experience working one-on-one. That's not how it works there. We don't want to listen, we think we know everything. Um, and then it creates conflict between both parties, and it's unsuccessful. Not necessarily that the strategies wouldn't have been successful, but because collaboration wasn't set from the beginning, it just went down the wrong path.

SPEAKER_00: 46:36

Yeah. And I think, you know, no matter who you're working with, I think you need to ask them, here's my ideas. What do you see as the possible barriers to that? Okay, it's like being in sales, right? Like you've got to be like ready to think about what their objections are gonna be and what you're gonna say. And it's kind of like that, you know, you're like, I know that they're gonna tell me X, Y, Z, and I need to show them how making this as easy for them as possible. Oh, you think that's too much data collection? Let me show you how to make it easier. Tell me about your day. So let me figure out how to filter that into what you're doing already. And us being flexible and making sure that we're working within the environment and restrictions that we have there and not just trying to tell the whole environment it needs to change.

SPEAKER_05: 47:14

Yeah.

SPEAKER_00: 47:15

That's not practical.

SPEAKER_05: 47:16

I'm sure those really help you with the consulting gig. So you can really share that wide variety of perspectives as a consultant and really open up people's eyes. That has to be really, really uh helpful for you.

SPEAKER_00: 47:27

Yeah, yeah, for sure. Um, so after I left that hospital, that is when I finally got into autism.

SPEAKER_03: 47:34

Okay.

SPEAKER_00: 47:35

Finally got into autism therapy. I worked, uh I moved to Charlotte, North Carolina. So I've now worked in three states. Um, and uh I did in-home therapy uh for, and this is the first time never in my life as a behavior analyst. At that point, I had been doing this for a long time. Had anyone handed me a book and said, This is what you use to assess this person, and this is what you use to program for this person. My whole life it had been you walk in, you say, What is the probable behavior? What are we trying to change? What's the replacement behavior? What do you mean to like be happier and functioning better in your life and environment? We're gonna work on that. And so it was so foreign to me that I'm like, what do you mean you just pull things out of a curriculum and like plop them into something? Okay. They know better than you do know.

SPEAKER_05: 48:22

The people who write the curriculum know that client better than you do.

SPEAKER_00: 48:26

Yeah, so I'm just like, there's no artistry in this. So I took that VB map book that someone handed me, I just like flung it and I was like, I don't know what to do with that. So I'm just gonna like see what the programs are that are in there. I'm gonna do my best to figure out where they're trying to go with this. I'm gonna get to know these families and stuff, and I'm just gonna like do the best that I can in this environment. Like I know what the verbal operants are. Which again, back you know, back when I worked for the state, I remember the psychologist I worked with at the time, and he and I are still friends, but I knew what a tact and a man and stuff was in that environment. He's like, Oh, nobody knows what verbal operants are because you didn't do that then. Nobody knew what verbal operants were. That was like very foreign concept, but I was like, Oh, yeah, I know what those things are. Um, so, anyways, fast forward to working in home, and the way that it was kind of set up was you know, uh, the culture was the behavior analyst is only there when you see them. If you're an RBT, actually, there were no RBTs yet, but you don't call the behavior analyst, right? They're not paid to talk to you outside of session time. You don't call, you don't ask questions as the parent, unless this is okay. Parent training meeting, you don't call the behavior analyst. That's the culture that I was into. And because there was no thought of like how many daytime versus afternoon cases, I had majority afternoon cases. So I got to see everyone once every two weeks. And I like these poor people that have like no experience with anything are just like on an island for two weeks between getting to see me. I'm like, you know what, I don't care if I get to gate or not, you're gonna call me and you're gonna text me because I gotta know what's going on with my case. And if you're struggling, I'm not gonna leave you out for two weeks.

SPEAKER_03: 49:57

Nice. That's that's um wow, I don't even know where to where to jump off on this. You've you said so much. So there's I guess the first thing I'd I'd be curious in knowing your uh your insight on is what's your impression on why it turned into that? So you you came into this autism treatment piece uh from a whole different realm, and then you know, you you uh described it so concisely. All of a sudden there's a templated, sort of uh replicated, not really sure if it's individualized, but we're gonna say it is because that's a good buzzword. Um what you know, is it just proliferation that that turned it into that? What what's your impression?

SPEAKER_00: 50:40

So I think what it is is that um you're gonna get you're getting paid by the insurance, right? Like every job I've ever had before that, there was some other government entity, big budget, whatever the case may be, that's funding this. And so if I'm at work and doing my job, like that's all I need to be doing. Even people that were behavior analysts in the waiver program, you know, they didn't have to worry about it like that. It wasn't like every hour always be billing kind of situation that was going on there. Um I think the company I worked for at this time too tried to expand very, very quickly. Yeah. And so clients were kind of spread out. And so, like one of the clients I got was like three hours away in the mountains of North Carolina, and they're like, well, because that person's so far away, do it telehealth one time a month and go out there in person one time a month. And I'm thinking to myself, like, probably what should have happened is you just shouldn't have taken this case if there's nobody that actually lives there to do this. And that's the first time I ever did telehealth. So I was like, okay, we'll figure this out. And this is in like 2012, 2013, something like that. Um, but I'm like, okay, you know, I'll I'll figure it out, I'll do it. Um, and here's the thing I think this is very important to say. Up to this point in my career, I had never made more than$40,000. That was like the I made$40,000. Okay. I think when I left the state of Georgia, I might have made$45,000 because I got promoted to running that whole program. And I was a BCBA then finally, and I um and I um took on some additional duties and stuff like that. So I maybe was making$45,000. And someone told me that um, or when they called me about this job, they're like, you're gonna be making$70,000 a year. And I was like, whoa.

SPEAKER_03: 52:26

Hey, this is your ever-grateful co-host, Mike Rubio. This concludes part one of our interview with Nicole Parks. Please return for part two and always analyze responsibility.

SPEAKER_02: 52:39

ABA on fact 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.