Do paraprofessionals need more training?

The article below is a heartbreaking one, especially since I have been witness to negative behavior but unable to do anything about it because it was coming from someone above me on the chain of command. It raises an interesting question: do paraprofessionals get enough training?

I have noticed a trend of younger and younger staff being brought onto autism organizations to act as specialists, interventionists, and techs. At one point, I saw many positions on the front lines only needing a high school diploma, and the pay reflected this as well (and sadly, I have learned, still does). They are quickly trained on the basics of the therapeutic approach, some bit on autism, and then released into the wild. I have seen new hires come to me looking like deer in highlights after a week into the position. Despite all of their “training,” they know little about the actual in and outs of autism, and may have little to no direct experience.

That’s not to say that with guidance, they can’t learn. I can think of one young man in particular who I got to interview for a Behavioral Interventionist position. He didn’t have much experience with autism, but he wanted to learn. The dude was a sponge, soaking up everything those of us with experience told him. Within 6 months, he became an amazing BI.

Still, I saw so many bail on the job after a few months (or get fired) because they couldn’t handle it. They at least had the insight to know that this wasn’t for them. The scariest ones to me are the ones like the aide in the article, the ones who either don’t care or have several chips on their shoulders.

Despite all of our knowledge and experience, I still believe that the parents are the ones who know their kids best. I cringe whenever someone in the field says that “we’re the experts.” That’s my second least favorite statement, right next to “fix them.”

In any case, this is an open question. Do you feel that the paraprofessionals in the autism field need more autism training? Is there another solution to keep stories like this from happening?

My Paraprofessional Was Supposed to Help Me

Here is another article discussing the issue from Psychology Today: The Para-professional-Student Relationship

The Bridge: Siblings

In working with child and teen clients, I have seen other professionals address the subject of siblings in one of two ways: inclusion or exclusion.

Thankfully, most of the time there is some degree of inclusion. Siblings are an intricate part of the everyday life of a child, and when the child is on the spectrum, brothers and sisters can take on a much more important role.

In most of my experiences (but not all), the siblings have been neurotypical. They are having a host of emotions regarding their autistic brother or sister: they are at times protective, sometimes jealous (because of the attention their sibling gets), often a bit confused as to how they can help, but almost always coming from a place of love.

For workers and professionals, they can present a challenge. The siblings often want to be involved in some way, particularly if the therapy is a play-based approach like I tend to use. They see the “cool” things I’m doing with their sibling, and naturally they want to be a part of it. Completely cutting the sibling out of the play (or worse, telling them that I’m only there for the client) can have negative results; the sibling may start acting out or “sabotaging” the session. Of course, if they have too much freedom, they could undercut whatever the worker is trying to do.

Here are some of the things I have done to incorporate the siblings into the sessions in a constructive way:

  • Sometimes, they just want to play with the “new” toys (if a worker brings toys) . With one family, I started giving the older brother his “own” toy/play station at the start of the session. This greatly minimized his tendency to snatch toys from my client.
  • Doing activities that all of the siblings (and ideally all of the family members) can participate in equally. Active games like ball games (kicking/rolling back and forth), art activities (fine motor skills treasure troves!), and board games (turn-taking, social interaction) are great ways to have fun, work on skills, and involve everyone.
  • Enlisting the siblings to help their autistic brothers and sisters. I honestly believe that kids want to be loved, accepted, and praised, and this is a great way to fold that in. I have seen parents do this really well, and in a variety of ways. The easiest way is having the sibling model some behavior or routine that they would like the autistic child or teen to pick up on. The praise they receive for their help does a lot to raise the self-esteem of both siblings.
  • Cooking can be a great activity, especially if any or all of the kids/teens show an interest in doing so. Interventionists have created some great cooking sessions where they have made everything from sandwiches to stews with the family. Make sure to use safety first!

I always try to talk to the siblings in some context, even if it is just a check-in while writing up my note or setting up. They often feel left out when their neurodiverse siblings have special friends coming in to work with just them. Looking at it from the neurotypical sibling’s viewpoint, I can see why they would feel isolated in that sense. I also make a point to commend the parents who have fine tuned the delicate art of giving all of the kids quality time, because it is by no means an easy feat. I encourage my fellow professionals to do the same. 🙂

 

The Bridge: About Eye Contact

One thing that I have noticed in the autism field is that there are very few autistic voices. This is unfortunate, because as workers we can learn a lot from those who have gone through the very therapy that we are now giving. Listening to the experiences of those on the receiving end is not just a good idea business-wise; in our field, it is just plain humane.

When it comes to eye contact, the main point that I have heard from autistic adults is that it is simply not easy for them. It is not a matter of being insubordinate or even stubborn, it is just difficult. I myself can attest to this: I have a hard time with eye contact as well. I often how to remind myself to do it, otherwise my eyes will just dart everywhere else. For me, it is very intense, and I can see immediately what the other person thinks of me through their eyes. That can be hard to face, because no matter how nice their words are, their eyes give them away.

So when I see interventionists and specialists trying to get eye contact by force, it makes me cringe, hard. While it is a valuable skill that helps you with nonverbal cues, forcing anyone into it (especially by physical restraint, which sadly I have heard of occurring) is just wrong.

I have to make eye contact enticing, something worth the action to the client. So, I hold up a desired object to my face, preferably aligned with my eyes. With Peter, it took a few times, but he eventually met eyes with me. I thanked him and gave him the object. I didn’t pull the object away if he didn’t make eye contact, because I knew he simply wasn’t comfortable enough yet. Once he was, the eye contact became more frequent. Eventually, he started looking at me first and THEN the object, indicating that he would like to have it.

Again, the key point was that I did not force him. I never held his face in place. I never punished him or withheld an object because he didn’t make eye contact. I didn’t want to punish Peter for doing what feels comfortable to him. I did want to teach him that he can ease out of his comfort zone (in his own time), and that there were good things to be had by doing so.

This simple action will now become the baseline for any other work going forward. Eye contact will lead to more interactions, and to the beginning stages of speech. If at any point I see Peter’s eye contact drop back into his comfort zone, I know that I either pushed too much or he simply needs a break. Either way, I take a step back (sometimes literally). In all of this (and I cannot stress this enough), I want to make sure that these initial steps are taken with care and an open mind. This will be important later, when the more challenging behaviors emerge.

Goal of session three: Start eye contact, while maintaining a suitable comfort level

Next week: We will start looking at some of the behaviors that “scare” newcomers to the autism field.

The Bridge: 3,2,1…Contact!

Last week, we met our new client and collected as much information as we could on them. Among the data that we gathered was the fact that they LOVE toy trains. So, guess what I brought to the next session?

Peter likes to line up the toy trains, and then rearrange the order. He gets very excited whenever he does this. Rather than deter him from the activity (which is sometimes the first instinct), I decide to take a different approach.

First, I do not give Peter all of the trains that I have. I keep at least three of them. When he starts lining his trains up, I start to do the same and match his enthusiasm. In fact, I may actually get more into the trains, though not enough to disorient him. While doing this, I don’t immediately interact with him. This is only the second session, and as a newcomer I do not have that privilege just yet.

Then, it happens.

Peter pauses and makes brief eye contact with me…but it’s longer than any time previous. He then goes right back to his trains. My immediate response is: “Peter, you looked at me!” in a quiet but enthused tone. With this I achieve two things: I acknowledge his communication attempt, and I indicate that I am happy with this action. After that, I go right back to my trains as well.

One of the biggest problems I see here from Interventionists and Specialists is a lack of patience and a need to perform. This is especially true if a parent/caretaker if observing the session. It’s normal to feel this way, to feel nervous about how the entire family is viewing you, your actions, and your expertise. It is important, however, to remember why you are there, and to trust your intuition. When reviewing video with workers after their session, or in feedback meetings following sessions, the workers often knew what they should have been doing, but became intimidated by what they thought the family wanted them to do. If you feel this happening to you, don’t be afraid to have a conversation with the family about what the expectations are. Are there certain therapeutic approaches that they prefer? How willing are they to try other possibilities? If the client is verbal, you can also ask them. I have had treatment plan meetings where the clients (in my case, autistic preteens) had a say in their goals and their progress.

Back to Peter. More than likely, I will not push him much further beyond eye contact on the second session. I will also make a point to explain my method to the parents so that everyone is on the same page. That will save you a lot of confusion down the road: lay a plan out to the family, and review what you worked on at the end of the session before you leave.

Goal of session two: Acknowledgement/contact

Next week, we’ll look at how to build on that “blink and you’ll miss it” eye contact.

PS- The title is an 80’s reference. Can my 80’s Babies guess what I’m referring to? 🙂

New Series

After thinking about it for awhile, I decided to write a series about how I work with my clients. I have met many newcomers to the autism therapy community, some coming into their very first job, and they often hit the ground running with very little knowledge of how to interact with their new client. In the companies that I have worked for, most of the training falls on the lower level supervisors. Unfortunately, they are usually swamped and can’t do full on training until their schedules allow them to shadow or meet with their employees. I know this because I have been the supervisor before.

My hope is that this series of articles will help incoming interventionists and specialists look at their charges not from the standpoint of data collection or trial running, but from the standpoint of relationship building and earning trust. While every client is different, there are some universal truths to interacting with any human being that (for some odd reason) I have sometimes seen ignored when dealing with autism.

I will probably start this early next week, walking you through my experiences as a therapist, interventionist, and specialist. I hope that some of you that are new to your positions and the field get a feel for what sessions can be like, and why you really shouldn’t take a lot of things personal or be too hard on yourself. For those who are “veterans,” I hope to remind you of why you do the work that you do. 🙂

Next week’s first article is: The Approach