By Alison Walker
CentralReach Implementation Coordinator, BCBA
“Alone we can do so little; together we can do so much.”
If you are an Applied Behavior Analysis provider, you know how critical it is to develop a collaborative relationship with your clients’ parents and/or caregivers. You spend hours explaining evaluation results, describing goals and interventions, and training parents to support their child using the plans you have developed. How often, however, do we all fail to fully recognize the contributions of the professionals who work with our clients in other therapeutic disciplines?
The Challenge of Coordination
Even when we are aware of other services the child is receiving, practical considerations can make it difficult to facilitate collaborative relationships with these other service providers. A client and his or her family may be working with an extensive team of professionals which can include speech, occupational, or physical therapists, plus physicians, counselors, and teachers — all with busy schedules and limited funding available for collaborating with others. The Committee on Children with Disabilities of the American Academy of Pediatrics recognized the challenges with coordinating care for children with disabilities, stating:
Care coordination often is complicated because there is no single entry point to multiple systems of care, and complex criteria determine the availability of funding and services among public and private payers. Economic and sociocultural barriers to coordination of care exist and affect families and health care professionals. (Committee on Children with Disabilities, 1999)
In reality, most of the burden of sharing information between providers falls to the parents because they are the decision makers and information brokers between the different services and coordinating team members. This can be a frustrating situation for families who are already under a great amount of stress. Megan, a mother of a 5-year-old boy with autism spectrum disorder (ASD), expressed the difficulty of being in that position:
A huge struggle for all parties involved is that the cross over or overlap of providers (teachers, SLP, OT, PT, etc.) is solely reliant on the parent to provide information on what is happening in each therapy goal, approach, successes, and struggles. I, as the parent, know a lot, but I don’t understand the methodology behind all the therapies and can’t dispute or argue for the best practice for my kid. I think it would be a good conversation, a very long discussion, about how to best serve the kid they are working with. But who has time for that? It would be a logistical nightmare.
Because nearly all evidence-based interventions (even those used in other disciplines) are behaviorally based, Board Certified Behavior Analysts (BCBAs) are in a prime position to relieve some of this pressure on parents and take the lead in coordinating care for their clients (Dillenburger et al, 2014). The Behavior Analyst Certification Board (BACB) also recommends collaboration to “ensure client progress through efforts to coordinate care and ensure consistency including during transition periods and discharge” (2014).
Below are four tips to cultivate communication and multidisciplinary coordination of care.
1. Know Your Team
As part of your onboarding process, ask parents and caregivers for a list of other service providers and their contact information. To ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, have the child’s parents complete a HIPAA Release of Information form for each service provider outside of your agency.
2. Give and Take
While it would be great to meet with all providers at one time on a regular basis, it can indeed be a logistical nightmare. Consider reaching out to other providers on a regular schedule:
- Prior to an evaluation or re-evaluation, gather information to gain insight into the client’s progress and challenges in other domains and settings.
- Following an evaluation or re-evaluation, return the favor by sharing the results and your recommendations for goals and interventions. This can be as simple as sharing a copy of your evaluation report.
3. Huddle Up
Take advantage of events that are already occurring. It might be difficult to get other providers to participate in a meeting strictly for the purposes of collaboration, but each specialty will have some kind of contact where they evaluate the client’s progress. If you can attend some of these meetings, it will inform your own practice and help you share relevant information with other providers who aren’t physically (or digitally!) present. Extend invitations to the other providers when you hold progress meetings. If invitations are ongoing, it creates more opportunities for all of the disciplines to make contact.
4. Plug In
Leverage technology to increase your ability to attend important meetings and share information. Smartphones and live video streams can allow providers to see client behavior in different settings and therapy modalities. A comprehensive practice management and electronic health record (EHR) technology solution, like CentralReach, can facilitate the sharing of documents and data in a HIPAA-compliant environment. Think creatively and use digital technologies to increase the frequency and quality of communication with team members.
While it is true that collaboration can bring up complex issues regarding theoretical orientations and professional styles, engaging in these conversations allows us to better meet our ethical obligation to evaluate treatments and recommend the most scientifically supported treatment for our clients (BACB, 2014). A deliberate effort to coordinate care can lead to less stress for families, more streamlined treatment, and ultimately, better outcomes for both clients and providers. For all of us who serve children with disabilities and their families, that’s what really matters.
About the Author
Alison Walker, MS, BCBA, LBA, has been working professionally with individuals with disabilities since 2003. In her history as a group home coordinator, special education teacher, school district Autism/Behavior specialist, in-home program supervisor, and supervising BCBA candidates and RBTs in a large clinic, Alison has had boots-on-the-ground experience in a wide variety of ABA roles and settings. In each of these settings, she has seen the strain in the system caused by an overabundance of children needing help and the limited number of qualified professionals available to provide much-needed services. Because of this, she is passionate about helping clinicians work smarter, not harder, so they are able to spend less time on administrative tasks and more time supporting staff and helping clients.