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

Job Accommodation

At one of the previous agencies I worked at, we had quite a bit of space in the very beginning as far as our office went. I remember us having several conversations amongst ourselves about creating a sort of “quiet room” for employees to relax in. We also discussed such a room for or clients, who were autistic. We even thought up designs for the space; pillows, dim lighting (no florescent lights), a small relaxation fountain, etc. Needless to say, that lovely vision never saw the light of day.

Employers are required by laws (to a…reasonable extent, I’ll say) to accommodate for people with disabilities and special needs. They are encouraged in the United States to hire such individuals so as to appear inclusive. Ideally, this would happen regularly. As someone who has worked in HR, though, I can tell you that I have often witnessed quite the opposite.

That brings me to the article below. The consulting form EY talks with The Atlantic about hiring and accommodating autistic employees. To do this, every aspect of hiring and retaining had to be re-examined, from interviews, to interviews, to company culture. EY took this into consideration on all levels, and as a result has a more talented and complex employee demographic.

A lot of the tech companies are starting to actively adjust themselves in order to tap into a population who can make great employees if they are given the opportunity. Right now, EY is placing these employees in areas such as cybersecurity. My hope is that other industries will start to create similar programs to recruit and retain autistic individuals.

EY Describes it Program for Autistic Employees

Purpose

I started an 8 week training on DIR/Floortime yesterday. I am very familiar with the approach, but I still wanted to have more formal training on it and the techniques. The trainer was well-versed in both DIR and ABA, and she strongly preferred DIR (which makes sense if she’s training in it).

After the first training, we spoke casually for a few minutes. She had mentioned her middle son, who is autistic and is now a young adult, during the training a bit. Now, though, as we spoke about my thesis, she revealed something very personal.

She said that while her son is productive (has a job, a girlfriend, lives on his own), he is frustrated that he hasn’t found meaning in his life yet. He doesn’t know his purpose, and this bothers him enough that he mentions it to her. She doesn’t know how to address it with him.

While this is not an uncommon issue with those in their early 20’s (or older, to be honest), it seems especially hard for those who are just trying to navigate a system and society not set up for them. It is hard to focus on purpose when you are literally in survival mode all of the time.

I hope that at some point during the training, I can talk to her further about her son. The fact that she told me this, that our conversation went there, is no accident. This is, in fact, part of my own purpose…to help others figure out theirs.

 

Off-topic: I started a part-time job for income while I start setting up the next evolution of SPARC here in LA. Yes, SPARC is going to evolve a bit. The part time job is exposing me to the agencies and practices that are typical in southern California (which will be very helpful later on). Having seen how agencies work here, I am adjusting to both fit in and stand out. That, of course, will take some time. I am super excited about the prospects, though!

A Letter To Disney

Over the last few months, I have been both amazed and greatly encouraged by the amount of autism awareness that is starting to be raised in the private sector. While other parts of the world have certainly been ahead of us Americans in that sense, we are starting to realize the potential of a workforce that companies have not given much of a chance in the past.

Disney has been a regular source of enjoyment and bridge-building for many of my clients, regardless of their demographics. Being a Disney kid/adult myself, I personally know what impact it has. I remember the joy (again, as an adult) at seeing an African-American Disney princess emerge on the scene with The Princess and the Frog. The Disney brand has significant clout in the world, and that includes the autism world within it. For many of the families I’ve worked with, being familiar with Disney gave a clinician a much greater chance at earning the trust of our clients.

The article below is from an autistic adult who now speaks with corporations and organizations to make the case for hiring his demographic. He also does an aspect of what I like to do, which is train the current workforce on working with autistic employees and coworkers.

A Letter To Disney

Teaching The Teachers

Last week, I had a team meeting with staff that I don’t see on a day to day basis. Being independent contractors, we are all rarely in the office. Opportunities to interact and review case studies are welcomed meetings.

At one point, I was discussing a case of one of my younger kiddos, who has Down Syndrome. When I causally said “my Down Syndrome client,” my supervisor corrected me by saying, “You mean your client with Down Syndrome.”

I paused, and then nodded. “Right, sorry. I guess my autism references rubbed off, because I often say ‘autistic adults’ or ‘autistic children,’ because the adults on the spectrum I’ve talked to prefer I say it that way.”

You should have seen the shock that swept across the table. “REALLY?!” they all exclaimed. This was a table of developmental specialists, speech therapists, and occupational therapists who have all had at least one autistic client at some point. This was a newsflash for them.

This is by no means a definite across all autistic adults, because of course I don’t know all of them. What the above exchange does highlight, however, is the continued disconnect between intervention workers/programs and autistic individuals. I myself did not realize how much of a disconnect there was until I started researching ABA and how clients view the approach versus how ABA proponents do (spoiler alert: there is a HUGE disconnect). I then started looking at the different agencies and organizations that focus on autism…no signs of any autistic individuals in the agencies’ upper administration, even as an advisory position.

The organization I contract with is not really focused on autism, so I sort of give its staff and workers the benefit of the doubt. For more obvious ones like Autism Speaks, though, I think it is a warranted criticism. How can you properly support a group if you don’t include them in your organization? I’ve made a similar comparison before, but to me it is like creating the NAACP (National Association for the Advancement of Colored People), and then having an all white board at its head.

Bottom line, I’m glad to have shared that insight with my fellow professionals, but in reality, I really shouldn’t have had to.

The Bridge: About Behaviors

This is a topic of interest for me, so much so that I created a training for professionals on dealing with “difficult” behaviors in clients. When it comes to autism, difficult usually refers to behaviors that are inconvenient, unnerving or harmful, or possibly embarrassing.  They range from persistent flapping to self-harm, and cover all points in between. The bottom line with all of them, however, is usually the same with families and adults who work closely with the clients: they would like the behaviors to reduce or stop.

In the training, I challenge my colleagues to become detectives first, and to view the behaviors from the eyes of our client. So, let’s take a new client, Paige. She is 14 years old, and nonverbal. She does not yet use any devices to communicate, aside from occasional pictures similar to PECS.

Paige often takes off running for no apparent reason. Sometimes it is just into another room, but sometimes it leads to her running towards traffic or out of the family home. Her family have no idea how to stop it and are deeply concerned for her safety. There are two things that need to be addressed almost simultaneously: Paige’s safety and the reasons behind her running.

A safety plan may be set up immediately, and nothing punishing is involved in it. Doors are kept secure, and someone stays with her regularly until the next step is engaged. At the same time, we start walking through a loose version of ABC (Antecedent, Behavior, Consequence) Data collection. This is one of the aspects of ABA that I actually like, because it brings in the detective aspect. We start examining all the events immediately leading up to the bursts of running, and I document them. After a few minutes, a pattern is noted. She tends to run when a large number of people enter the room she is in (about 3 or more). This is especially true if she is given no warning (for example, if neighbors or family members unexpectedly drop by). If Paige did have a device to communicate (or was verbal), I would more than likely get her input as well.

The family and I develop a plan to let Paige know when to expect an influx of people. We also let her know that if she gets overwhelmed, she can squeeze a trusted adult’s hand to let them know that she needs a break. Her receptive language has proven to be high, so we all believe that she definitely understands. This gives her some autonomy to tell us when she is feeling out of sorts, rather than us just assuming. After a few test runs, Paige is able to squeeze to alert her family. Within about three weeks, her running has reduced by over 50%.

For many behaviors like this, there is an underlying reason that we may be missing. It is usually something that a neurotypical individual would never guess, because it is not something that normally bothers us. This is why I like to reiterate how many neurodiverse brains tend to filter very differently from our own. This sets up a better sense of understanding from families and caregivers, and allows them to become better detectives and listen to their neurodiverse loved ones’ cues, whether they are verbal or not.

Next week: The behavior discussion continues with a look at the actions that aren’t harmful, but still baffle many of us. Have a great week, and feel free to email me with any questions/comments at sparcguidance@gmail.com.

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.