Megan W 

So welcome everybody to our clinical exchange. We're so excited to have Jen Farris joining us today. I know Jen and Marie met when through Autism Ontario, and Marie just raves about all your work and everything that you do. So we're so so excited to have you. She said to me once that she finds your approaches like compassionate and your care is just second to none. So we're absolutely thrilled to hear your words this afternoon. So Jen Farris, everybody is a BCBA and the founder and chief science officer of sprout MBC. She's working in the field of applied behavioral analysis. She's been working in the field for over 20 years, and has helped and has helped positions across all areas of direct and clinical leadership in schools, centers and in home. Jen has a passion for providing high quality ABA services using today's best practice, and as a self proclaimed data nerd, we love this. Her values as a BCBA align with providing compassionate care paired with both precision teaching and precision measurement. So when she's not working, she also loves to travel, spending time with her family, and she has three beautiful boys. So Jen, we're like, I said, just thrilled to have you, and can't wait to hear what you have to say this afternoon. You can take it away.

Jen Farris 

Thank you so much. What a lovely introduction. And I have to say, the feeling was very, very mutual. It was like, Kismet. I was like, you do this too, oh my goodness. It was really wonderful to hear the amazing work that Marie and her colleagues and all of you are doing. So thank you so much for having me. You can still see my slides. Yes. Okay, awesome. So like Megan said, I am Jen Ferris I am a BCBA, and here in the States, we have to have all these other letters attached to that, to a lava which means I'm licensed, and then also I'm an international behavior analyst. And I have a strong passion for for data and behavior analysis. This is my 22nd year in ABA, so I have a very kind of rich history with a lot of the things that we're going to talk about. I do want to say the journey that I'm sharing is mine. That's not consistent with the journey of everybody else. It's not consistent with our field as a whole. But I'm going to share my stories and my experience and outline how it impacted me to being the behavior analyst that I am today, and towards running my practice and in the way that we do. So compassion in science. So I went to chat GPT for these definitions I have my own, which we're going to talk about. And chat GBT said compassion is the emotional response of caring for others who are suffering or in distress, combined with a desire to help alleviate their pain. And so I think generally, anyone who works in the helping profession would say, I am compassionate, right? And that's true. That's That's not untrue, but that doesn't mean that you you practice compassionate care and compassionate behavior analysis, and so we're going to talk about the difference of of those things. I also say, will say that, like I might say some things that cause you to pause and reflect on your own practice. And I would say that part of that is the goal, that's the way that we learn and grow again, I'm going to speak to about myself and my experiences. But when I say to someone compassionate, ABA, they're like, I think I'm a compassionate person. And I'm like, You are a compassionate person, but your practice isn't necessarily aligned with that. And so we're going to talk a little bit about that, what that looks like. Okay? So then we also have science. What is science? Right? Science is a systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe. I was like, chatgpt - that's a cool definition. I really like that, and how we use that. We know that ABA is the science of human behavior, and I say the science of teaching, right? Everything a learner does is, is behavior and how we utilize those tools, is science. Now the challenge is, I think in the field of ABA, let's just call this what it is is many people believe that compassion and science live on opposite ends of this spectrum of practice. And I'm here to say, no, they don't. They actually join very, very nicely in the middle. We're not altering the science of behavior analysis by centering somebody their values, their feelings and their emotions. However. Sometimes we veer away from our science, right? Because we're still learning, how do we measure this? How do we how do we use that in our everyday life? So some of the there's some criticism in the field about a compassionate approach, unfortunately, right? And that is that as a science, we really value research, which is great, right? Having research is wonderful, though, valuing evidence based practice over the lived experience of our learners and clients, most would agree, isn't right, right? However, still, many stay and agree with that and say that there's not enough evidence to support it. So we're saying there's not enough evidence to support that we should, in a helping profession, put somebody humanity first. We don't need research to say that, right? Alternately, people say but it's worked this way for so long. Why would we change it? And my response to those criticisms are that when we learn better, it is our job to do better, right? And we have the opportunity every single day to learn more and do more and do things differently and decide how we want to show up in our next moment in time. People also say like, how do you ever get anything done if you just let your learner opt out all the time. Surprisingly, we get a lot done. We have a lot of really great outcomes. As a precision teacher, we're very outcome driven, you know, in terms of wanting our learner to be the best, most autonomous person that they can, the best version of themselves. And there's decades long intervention that have been used in precision teaching from Michael Fabrizio and others that show that happy learners who have choices embedded into their day make better outcomes. In addition, there's some emerging literature surrounding some similar things. Dr. Adithyan Rajaraman and colleagues out of Vanderbilt are talking about outcomes related to choice and how, when learners are given the option to work for something versus being given it for free, many times, will opt to work for it, a part of that is, is human nature and our innate kind of, no, I don't know the scientific word behind this, but our innate desire to do things and operate in the world in that way. And essentially, when we do do this, and we do honor our learners in this way, it builds trust and autonomy. So that's the goal. Okay, we're going to have a little lesson in history here for folks who are not familiar. In 1938 is when VF Skinner introduced the concept of operant conditioning, focus on how behavior can be modified through reinforcement and punishment. Okay, in 1961 the term applied behavior analysis, which is behavior analysis in application with humans, was coined by Baer, Wolf and Risley in their seminal article establishing ABA as a discipline, okay? So that actually wasn't that long ago. 1981 Lovaas published a landmark study titled Teaching Developmentally Disabled Children The Me Book, and the Lovaas model of behavior analysis was a very, very common one that was used for a long time. I have colleagues who have been in the field the same amount of time that I have that learned this model and implemented it and used it very early in their practice. It was very punitive model, also known as the No no method. Personally, I was not taught the Lovaas method, and so that's not anything that I ever used in my own practice, but it is something that that I hear many people, and again, colleagues who have been in the field the same amount of time that I have, or similar amounts of time. You know, we're using that method, and it worked. But that doesn't mean it was the best, most right thing to do. In the 2000s we have this emphasis on evidence based practice and importance of empirical research in developing effective ABA interventions. So over the course of the 2000s this has expanded, which is great evidence base is very important, it's very important to what we do. It's important that we're not just trying things willy nilly, that we don't know if they're going to work or not going to work. But also, you know, somewhere in there, there has to be space for somebody's lived experience, right? And so in the 2020s now, right? So we're talking about the last four years, we shift to our focus on diversity, equity and inclusion. Many who would say that is decades too late, a century too late, exploring culturally responsive practices, and I would add to that too, also neurodivergence, and neuro divergent practice as well is certainly something that is much more recent that folks are talking about in the field of behavior analysis. Okay, so now we're going to travel back in time. I. And I'm going to tell you a little bit about my own journey and behavior analysis. So it was the year 2009 in Western Massachusetts, folks who aren't familiar with what where, what that means in the world, and geographically, we're about two hours west of Boston and about two hours east of Albany, New York. So, yeah, that's the best I could describe it. And probably about two hours from we're about four hours from New York City, so up that way, so in New England. So I got a job. I'd been working with children with autism for a number of years. I, like many, fell into the field. I got a job out of college. I wasn't even done with college. I that's a story for another time, but essentially, it resulted in me not going to college anymore, and my parents said, Well, you better get a job. So that was in 2003 and in 2003 I went and I got a job. I responded to an ad in the paper, because that's how we did things then. And I got a job, working in a preschool classroom with non ambulatory, non verbal, aggressive children with autism. I had never met a person with autism before, and I had no idea what it meant to be autistic. I knew that I liked kids and that I had been good at working with kids in the past, when I had babysat or other things like that. So Boy, was I in for it, and I learned very, very quickly that it was exactly what I wanted to do for the rest of my life. And so fast forward a few years. I, you know, at that point I was, I was 19, and so I was being a 19 year old, and kind of, you know, bounced to a couple of different jobs. I moved out to Colorado for a little while, and then when I moved back, I landed, you know, fairly in Vermont, but fairly close to Western Massachusetts, and I had continued my work with autistic individuals, and I learned that I really kind of had a knack for data collection and for systematic instruction. And I learned that what I was doing and that what I really wanted to do was very, you know, good at, to be honest, was applied behavior analysis. And so I had been working alongside behavior analysts and the work I was doing and the owner of the company, you know, at that time, there weren't a lot of behavior analysts. If anyone in here is a behavior analyst and has seen, you know, that graph from the BACB at the time that I started in 2009 there were, like, less than 5000 behavior analysts worldwide. So it wasn't a common thing, not like today, where, you know, at least here in the States, there are jobs in ABA all over. It's actually highly competitive. It's quite strange, to be honest, but to the owner this organization, was like, Hey, if you, if you're like, really good at this, and you really love it. You know, I had been working for a service agency. And he said, Why don't you come work for my agency? He owned a small behavior analytic organization. And he said, I'll teach you how to be a behavior analyst. There's their certificates. Like, this is a is like, basically, like, this is a real thing. This is a science. You know, you're learning it in delivery, but come here and learn from me. And so I did. It was a great option. It was a very good move. I negotiated my initial certification courses for my VC, ABA. As part of my contract, I was with the organization for seven years, and I was hired to be, you know, what now is called an RBT, but was called a BI then a behavioral interventionist. And, you know, there, there was no RBT credential at that point in time this, this predates that by quite a while, and he's like, we're building this program housed in a school, but it's substantially separate for, you know, all the kids that were sitting down in a district, they're coming back, we're going to build this program for them. I said, Great, that sounds awesome. And it was awesome. And I was assigned to work one to one with this, an autistic girl. She was, I think, roughly like eight or nine years old at the time, and the day that I met her, she engaged in 240 instances of self injurious behavior per hour. But that sink in. That's per hour. And we had a 6.25 hour school day, and I was like, oh, okay, we're gonna do this. I don't really know what to do. I wasn't supposed to know what to do, but I learned what to do. And. And what I learned how to do was discrete trial, instruction, functional communication, training and lots of things that I don't do anymore, that included escape extinction from a table, compliance training, using physical management and restraint to mitigate problem behavior and as a way of safety and protection, non exclusionary time out procedures. Exclusionary time out procedures, we didn't use seclusion in our program, but lots of other people were using seclusion. In fact, some places still do, and that's what we did. And so I learned to implement very, very systematic instruction. Taught her how to talk using a device. Well, eventually using a device, because when we first started, iPads hadn't come out yet. They literally hadn't been invented. And so we had these low tech alternatives. We called them manned boards, similar to pecs, but a little bit different, a little less cumbersome to carry around. And so we taught her how to talk. We taught her some skills related to helping to keep her, you know, her hands safe. We taught her to have a calm body and a quiet voice. We taught her to not engage in stereotypy, and we taught her that if you hit yourself or somebody else, we're going to put our hands on you to stop you. Now, when I say that, now, it sounds awful, right? And nobody wants to have to do that, but that is the way that practice looked then that is what most people's practice looked like. And what I'll say is it was efficacious. It worked. By the time I stopped working with her a year and a half later, she hadn't engaged in any self injury for weeks at a time. Initially she engaged in self injury, she had a unicorn, basically, like on her head, like a part of her skull was protruding out of her forehead that looked like a unicorn, the same in the back, she had bruises up and down her arms and legs. She could, from a standing position, take her knee from the floor and hit herself in the head. It was very, very well practiced, and so the reduction of the severe self injury went down rather quickly. But then there was other variations of like tapping her she tap her elbows against tables, or like, take her hand and put it up to her chin and tap all these other ways that were still, you know, you could hear them like it wasn't, it wasn't soft, it wasn't a soft, you know, touch, tap, it was, you know, it was hard. And so by the time, yeah, over those 18 months, we reduced the problem behavior successfully to zero instances. We were using current research. It's interesting, the researcher that I followed the most then is actually still the same researcher that I follow the most now, Dr Greg Hanley and I followed his work this entire time. Lucky for us, he only lives about 45 minutes from here, and so, you know, I've been benefited greatly from our local conferences where I saw him present, and being able to have access to that research and good mentorship to teach me how to do that. But, yeah, it worked. That's what we did. And everybody did that. In fact, some people did more than that, you know, there were, you know, inpatient programs or residential schools that were using mechanical equipment, that were using modified desks, arm splints, you know, all sorts of stuff. And now, so now let's fast forward a little bit to let's see when was this. This was about May 2024 I was in a classroom, and I was observing a student, and it was very reminiscent of my days in 2009 with the learner I just described. I went to do an assessment in a school based program, and this girl with autism wanted to have some strawberry milk, but she wasn't allowed to have strawberry milk, right then, for those who aren't familiar with strawberry milk, there's like, strawberry syrup that you just put into a cup of milk, just like you would chocolate milk. I think it tastes weird. My kids love it, but so she wanted this, right? And she tried to take it out of the fridge. And so they blocked her and said, You can't, you know you can't do that. And she started engaging in self injury to the head. And she did it 56 times in 15 minutes or 20 minute time span. Before I said, please stop somebody. Please stop and give this child the strawberry milk. This isn't worth it. And so that's one of the big things that I learned, is, is this worth it, right? Is this worth it in this moment? Does compliance matter more than this? And so I said, the people looked at me like I was nuts, and I they never met me before and this was day one of an assessment, and I was like, I realized that what I'm telling you may be exactly the opposite of what any behavior analyst has ever told you before, but I'm asking you please give the girl the strawberry milk. And what do you think happened? She stopped, and so this had gone on, you know, she was trying to elope out of a door, hit her head against the door, they blocked her, right? They put foam there, she ate the foam, she threw it, she hit the person, right? All of these things, all the whole thing, you can envision the whole thing happening. And I said, What if you just gave her the strawberry milk every time? And they said, well, we can't do that. I said, How come? They said, she'll never learn anything. And I looked at them, and I said, I thought I was not going to be invited back, but I said, Well, is she learning anything right now? And they were like, well, I guess not. And so that's my journey. I know a lot of colleagues that their journeys are similar, and I know a lot of colleagues who are on that journey now, and it was very interesting perspective for me to go from that initial these learners were very, very, very similar, and it was interesting to sit back now as I've been a behavior analyst for 10 years. You know, that was 15 years ago to say, Wow, what a different person I am and what a different practitioner I am. And, you know, I think we all have the ability to be able to do that and decide how we want to show up tomorrow. Okay, before I get on that soapbox too much, what does it mean to practice compassionate ABA? So to me, responding to complex behaviors compassionately, means that you're continually centering the individual's well being over the desired outcome. Whether that outcome is compliance based or otherwise. It means being flexible in your approach to know that you can back out of a demand if this situation is too distressing for a learner, or, quite frankly, too distressing for you, and that you can continually evaluate whether that is or isn't what you're going to do next time. Our interventions and interactions should be kind, well intended, free of coercion, centering ascent, and rid of any power dynamics. Our outcome should be intentional in that what we're looking for is in the best interest of our learners, and in fact, what they would like. Measures of social validity go back in behavior analysis to Don Baer, Dr Don Baer at the University of Kansas, it was 1978 was the first published research article on social validity. I don't know why people think that that's new. That's not new. I wasn't, in fact, born at that time, and given that I've been in this field for 22 years, that's saying something. It's a very important part of what we do. It's essential that our interventions feel good to the person who is providing treatment therapy too and are in line with their values. And my practice, I tell people, don't ever compromise your values. If somebody is asking you to do something no matter what or where you are that is not in line with your values, don't do it. I'm not going to do it. It would be unfair for me to expect for them to do it. We should be able to globally broadcast what we're doing on television, on the evening news, and have everyone in the world be able to say, Wow, that was well intended, gently implemented and kind. And when we evaluate our own practice, if we cannot say an adamant yes to all of those things, we should continue to pause for some self reflection and some updates on our practice.

A little more history. Some of you guys might know who that guy is. That's BF Skinner. BF Skinner talked about radical behaviorism, and radical behaviorism acknowledges private events and recognizes that they influence behavior though we cannot see them. So what that means is all of our learners, just like all of us, come to the table with feelings and emotions, imagine that. They come with their learning histories, which for many of them include trauma, right or adverse childhood events. It's not for us to decide whether it was or wasn't trauma. It's up to us to acknowledge that those things exist, and that is a part of the makeup of each one of our learners, just like it's a part of makeup of each one of us. Okay, so I like this compassion is continuously centering the needs and the well being of the learner over compliance. That means you can bow out at any time. Anytime a situation becomes too distressing. You get to decide, do I want to continue to do this right now, or do I not? And then what you must answer for yourself, just like I must answer for myself, is, why? What am I centering here? Am I centering my own desire for this to be done faster, better, correctly, whatever, or am I centering the needs of my learner right now in this moment? And if we can't say that it's the latter, then we shouldn't be doing it. Okay, but how do we do it? So that's me that's actually up up in Toronto, the day that that Marie and I did that wonderful panel, so how do we use it and so how we use it at Sprout, how I use it in my practice is we set up learning environments that build trust, rapport and understanding, where learners, participation and engagement and instruction is up to them, and that their voice will be honored and their autonomy will be prioritized. It's our job to work ourselves out of a job. If you worked yourself out of a job, it means you did a good job. If you have learners, and that's not to say there are learners who will need support for years, maybe their whole life, and that's okay, as long as they're making progress and working towards becoming the most autonomous, best version of themselves. However, there are many, many, many learners who do not need therapy long term, and so what we should be doing is prioritizing their health and their well being, addressing what is most important, and knowing that it's our job every day, just as it is theirs, to decide whether they're going to show up and show up in the way that they want to show up, just as we're going to show up in the way that we want to show up. Know that we're going to honor for them their participation and engagement, that if they're not ready, we're not going to make them and that we're going to continue to work towards not having a job. I often tell parents who come, you know, obviously our funding is different here in the States as it is there, and so here, you know, we don't have the same, you know, public health care systems, regrettably, in my opinion, but, and so our services are covered under insurance. Certainly, the benefit of that is that they're more widely accessible. And so I talk to parents all the time. Almost every single day, I'm talking to new parents who are trying to navigate this world of you know, having, having a child with autism, understanding the services you know, how, how they can get the best support, both as parents and for their children and all of that. And they often ask me, How long will they be in treatment and or in therapy? And I say the goal is for the least amount possible. We shouldn't have the goal that we're going to have. You know, it used to be said the gold standard was 40 hours a week for everybody. That's not true. A lot of people don't need 40 hours a week of ABA. That's a whole lot. I don't always need. I work in ABA, and I don't always want to do ABA for 40 hours a week and and it's my job, and I love it, and we can't expect that our learners should be doing that either. It's just it's just unnecessary. Anyway, that's a little bit of an aside, but it's our job to do the best that we can, while we can, to be able to work ourselves out of a job, okay, and to prioritize certain things. So the biggest thing to prioritize is safety, choice, collaboration, and then when we prioritize those things, we gain trust. And once we have trust, we can utilize that trust to build empowerment. Okay? That empowers our learners to be able to engage and exist in the world in the way that feels best for them, because they know we're not going to push you beyond the threshold that is comfortable for you. We're not going to make you do things that you don't want to do. We are here to help you. You are a decision maker in your own life. We're not here to tell you what you have to do. We're here to support you in what you want to do. You have choices about what you want to do or don't want to do. Right? However, safety is all always a priority. Okay, we always have to make sure safety is at the forefront of what we're doing. Okay? So there's a lot of different ways that we can do this. One of the models that I really like, and this comes out of research from Dr. Adithyan Rajaraman, he was at the University of Vanderbilt. He's now transitioning back into a role at FTF behavioral consulting here in Massachusetts, and it's called the enhanced choice model. So the enhanced choice model is a layered choice model that continually evaluates assent and assent withdrawal. It allows a learner to elect to engage in instruction and also to continually decide that they no longer want to participate or to participate and achieve reinforcement. So the option is, you can not participate at all, right? The other option is you can fully participate, right? Participate, earn reinforcement, get all the great things. Life is good living in the land of joy. Or you can say I'm not ready right now, so I'm going to go sit and chill for a little while, and once I feel ready, I'm going to come back and we can get started. Okay? And by a learner knowing that these are always the options, it takes the pressure off, right? I sometimes meet people and they'll say, Well, I told her to do this math work, or I told him to do this math work, and they didn't do it. And so I just kept saying, You gotta do it, or you're not going to go to recess. You got to do it, or you're not going to go to recess. And then they flip the table. And in my head, I'm like, I don't blame them. I actually might flip the table too, because we're sitting there and hounding kids to do things. They might be asking for help. They might not know how to do it. They might just need a minute. And instead of giving them a minute, we end up hounding them to try to do something. And then we see these complex behaviors emerge, right? And so by alleviating that and alleviating that pressure, it also brings the temperature down. It brings the temperature down on the behavior. I have a friend that says talks about EOS and introducing things. She calls it her spicy scale, you know, something's really spicy, you know, like a habanero, versus, I don't know, like a I don't really, like, really spicy things, so I don't know all the peppers, but like versus a jalapeno, right? A ghost pepper is a lot hotter than a jalapeno, so if you're introducing work that's equivalent to a ghost pepper, well, yeah, you're more likely to see big behaviors. If you're introducing work that's similar to a jalapeno, you're going to see less of those behaviors, right? And you can build that up over time in a way that feels you know, going back to our previous slide here, it feels better, right? We can build choice in there. We can build collaboration. And once we have that trust, we can make things a little bit harder and a little bit harder and move to a place where the learner feels empowered to be able to engage in those behaviors. Okay, so in addition to that, here's another, another. I really, I really like this visualization, not only because we're sprout and I love the idea of sprouting growth and sprouting learning and thinking about learning as, you know, a sprout as a metaphor for learning, right? We grow, and it becomes bigger and bigger and nourishing and all of these things. But I think this is a really nice job of looking at some skills that are really important, foundational skills, and kind of the root and then how we kind of branch those out so this is based off of skill based treatment, which is a treatment protocol established by Dr Greg Hanley and colleagues out of FTF behavioral the purpose of that protocol is to teach communication, to teach toleration, to to teach appropriate denial and to build out skills contextually appropriate behaviors is what they're called. That's what cab stands for, in a way that just gently pushes the boundary. The goal is to minimize the need to engage in complex or escalated unsafe behaviors by teaching these very small incremental steps to get where we're trying to go. Okay, so by teaching a functional communication response, which might say, you know, for this protocol, generally, they say, I want my way or my choice, please. Essentially, what it means is, no, no, I'm not ready. I need another minute. Okay? And then, as an instructor, you might say, I'm sorry I can't honor that. And that's a toleration response, because, in reality, that's a part of the world, right? I could say, oh, I need a vacation right now, but I can't take a vacation right now. I'm in the middle of this talk with y'all, and so I can't just get up and walk out. I mean, I guess I could, but that wouldn't, that wouldn't serve me very well in the long run. Right the way the world works is that sometimes that need gets met and sometimes it doesn't. So we can teach you you can get your need met, get your need met, get your need met, and then safely say, hey, sometimes you can't have your way, right? You can't always just do what you want to do. That's not how that's not how the world works, right? And so we can build that up slowly over time, in a way that it feels okay. It feels okay. If you you know, I have, like, you guys heard I have three boys at home sometimes before dinner, they're like, especially post Halloween, they're like, can I have candy? And I'm like, it is 7:45 at night and you are going to bed at 7:46 like, no, the answer is no, right? Now, you cannot have candy, right? That's just not an option. You know. Hey, can I go run in the road? No, you can't go running the road. That's not an option, right? So we can softly teach that you can always get what you want, right? We also need to teach sometimes you have to move away from the things you want to go to the things that you don't want, right? And that involves relinquishing. My oldest is 10, and he really loves his Xbox. And relinquishing is very hard for him. Sometime when we need to stop, he's not allowed to play it in the morning. But like when we need to stop and go someplace, and he's gotta get ready. If it's up to him, he'd stay in his pajamas all day. So like, on a Saturday, it'll be like, noon time, and I'm like, hey bud, you know you gotta get dressed. And he's like, you know, I'm playing my Xbox. Whatever I need another minute. Okay, you get another minute, no problem. But when I come back, you actually need to be all done, right? And so he has to learn to just accept that in some way, right, without throwing his stuff all over the place, because that's not safe. So that's that relinquishing thing, and then transitioning onto the other thing. Okay? So transitioning away from the thing we really love to the thing that we might not love as much, but is really essential part of learning and growing and becoming your best, most autonomous self, right? So you can see those branches are ADLs, including toileting, showering, washing, brushing your teeth, all those essential things, language. What does communication skills look like? Leisure, what do you like to do is that inside, is that outside? Pre vocation skills? At some point, do you want to have a job? What does that look like? How do we start learning that? What? How do Who do you want to be in your community? Exercise? You know, ELA, English, language, right? Math academics, okay, so we work to build these gently over time, to help build some resistance and also learn that there are other ways to get your needs met aside engaging in those unsafe behaviors.

Jen Farris 

Okay. What is assent based instruction? Okay, so when we're implementing ascent based instruction, it means that an implementer is continuously evaluating for our learners, participation and engagement that we're monitoring for signs of withdrawal and ascent and honoring such signs and signals. So dependent on your learner, depends on what that looks like. So if all of a sudden, let's say you were giving the presentation, and I was sitting here where I am, and I take out my phone and I just start scrolling. Would you view that as engagement or non engagement or disengagement? I would say it's probably disengagement, right? So you've disengaged from what is happening. And we would say that that's a assent withdrawal. You disengage because you no longer, presumably want to do this other thing. Now maybe you do and you want to multitask, and that's a different story. But this looks different for different learners. And so sometimes that could look simply like No thanks, right? Or it could look like I don't want to do that, or it can look like a push away, right, shoving materials away or moving them aside. It can look like standing up and walking away from the desk or the workspace lots of different ways. And so when we're able to identify also assent and assent withdrawal behaviors vary person to person and learner to learner. And so we must identify them for each of our learner individually, so that we know how to address those for each learner individually, what may be an ascent withdrawal behavior or an ascent behavior for one learner may not be the same for another. So what we do is we teach our techs and our BCBAs to be able to identify in each learner what those assent and assent behavior are. And now, because we are compassionate scientists, we also take data around that. So we're frequently tracking the frequency of assent withdrawal how many times within an instructional time did the learner engage in assent withdrawal behaviors. Sometimes ascent withdrawal behaviors are also dangerous behaviors, but I will say, if you're paying close attention, you will notice over time, those lower level precursor things. Oftentimes, if assent is not honored, the assent withdrawal is not honored, you will see an uptick of behavior, and the behavior will become bigger and bigger and bigger, right? And then you have this different problem on your hands, right? So for an example, as an instructor, you ask a learner to do something, whatever it is, it doesn't matter. And they go, and you're like, No, no, like, you need to do that right now. And they're like, you're like, No, no, no, you need to do. And they're like, right? And then they're yelling, this progression happened, right? And so what happens then, when the learners at the highest level, the instructor might be like, Oh, I see you're not ready, and I'm kind of like, well, didn't they tell you that, like, two minutes ago, you know? And so if we're continuously monitoring for that throughout our instruction, we're able to catch it before it becomes bigger, okay? Other signs of assent withdrawal, a learner might just physically turn their body away, might put their head down, might tell you no, might yell at expletives at you. That is a that is assent withdrawal, maybe not the most functional assent withdrawal behavior we might want, but we can also teach assent withdrawal behaviors early on. Say, I need a break. No, thank you. I don't want to do this or just accepting that those you know for for non speaking individuals, that they're going there's going to be behaviors that look different. And so I sometimes teach learners to do this or do this. My two year old likes to do that. And there's other ways that we can teach learners those assent, withdrawal behaviors that they don't already have them in their repertoire, so that we can honor that for them and really make sure that we're not getting to a place where instruction is becoming distressing for them. Now, does that mean that the whole rest of the day is out the window? And I'm going to say, No, it doesn't. It means you probably give them some time and then see what things look like. You know, people think there's a common misconception, at least here in the States, where when you honor assent, you let a learner do whatever they want. And that's not true. There are boundaries to everything that we do, and there are boundaries to honoring assent withdrawal. And a big one is safety. Is it safe to do is what you want to do dangerous? Will you get hurt and will it hurt somebody else? Okay, no, you cannot go running the road. No. You cannot stick your hand in an electrical socket. No, you cannot hit your friend. No, you cannot, I don't know, jump off of some high surface. You can't do that. You're just not allowed, uh, hygiene, is it? Is it clean? Are you staying clean? It's not a choice to never take a shower. Okay, you have to take a shower. Um, that's the hygienic thing to do. It's not good for your body. Is it what's best, Is it what's best for for you related to your cleanliness, right? You know, I'm not talking about being in your bed. Now. I really love a made bed, and I would say that that is the hygienic thing to do. But Is anybody physically going to be impacted by me not doing that? No, they're not okay. It's not actually impacting my health and wellness and then environmental specific things. So I do a lot of work in schools. There's lots of things in schools that you're not allowed to do, right? You're not allowed to stand on tables, you're not allowed to run up and down the hallway screaming, you're not allowed to disrobe. You're not allowed to just barge into the principal's office, right? There's lots of things you're not allowed to do, and you're just still not allowed to do those right. And so we can teach you to accept the things you're not allowed to do in a way that's safe, trustworthy and compassionate, versus waiting until those things occur and then need to intervene with more or less compassionate means. Okay? All right, I wanted to save some time for questions, so I have some, some an ending message for all of you guys, it's okay to do things differently. It's okay to do things differently than you did them. It's okay to do things differently than your colleague does them. It's okay to be an organization that does things differently. That is okay. It is okay to push back against the status quo for the sake of our our learners, folks who are advocating for our science to be better and different because of the impacts that it has had on them. It is okay for you to decide that the way you used to do things, you don't have to do it that way anymore. It's okay to not do the same thing tomorrow. The beauty of our science is that we implement systematic instruction over time. Reinforcement is a process that happens over time. If you reinforce the problem behavior today, that doesn't actually mean that something horrific is going to happen tomorrow. That is a misconception about the way that reinforcement actually works, and if it does, you actually can elect to do something different then, and that's okay, too. Using research that is 20 years old is antiquated. That's old news. That's not what we're supposed to be doing. There's plenty of current research that says, Hey, we should all be doing something different. It's out there. I'm actually going to give you a whole reference sheet on the next slide, that is a bunch of research that you can go and read some of this is, actually is 20 years old and has been there the whole time, okay? And that then when we learn better and we know better, we can do better. And so it's each one of our individuals responsibilities to decide, who do I want to be in the world. How do I want to show up in the world when somebody googles my name and applied behavior analysis, what do I want them to see? If what is found in Google is what is our lasting legacy of the work that we do that should tell us? What do we want people to remember us by? Do they want to remember us by the people who kept them at the table and want to let them go? Or do they want to remember us by the people who saw them saw each person for exactly who they are, help them learn and grow to be the best version of themselves in a way that was trustworthy and empathetic and compassionate and not coercive. Okay, so we all have a responsibility to ourselves, to our field, to our learners, to their families, to our communities, all of the things to decide who we want to be and then adjust. Okay. Okay. So some references for you. Here are some things I love the work of of Dr Hanley and and colleagues on the Iisca, or practical functional assessment skill based treatment. So you'll see some of those referenced here. There's also some, some great work by Jonathan Tarbox, or the Tarboxes and colleagues, preliminary framework, Dr Rajaraman, who I mentioned here. Also some, you know, treatment utility around the practical functional assessment and use. And also Dr Joe Lang, who's been talking about this for a very, very, very long time, on non linear thinking and a constructivist approach to behavior analysis. So I would love to both share my information and then open the floor for questions. Does that? Does that sound good? Is that a good time for us to do that? Megan, we good there,

Sara 

absolutely. Megan had a client. She stepped away. Finally, a great time for that. If you want to share your info. Jen, that that's great. They can reach out to you if they have more questions. And then, yeah, we definitely have some questions. If you're open to it awesome.

Jen Farris 

I am certainly open to questions. I love questions. Okay, so thank you so much for taking the time today to learn from me and learn with me. I'm excited for questions. If you're on Instagram, you can follow me at mybehaviorbrain. You can email me Jennifer@Sproutmvc.com website is sproutmvc.com and I have some a couple of projects coming up. One of those is in 2025 early 2025 I'm a co author on a curriculum that's called reframe. It should be released, ideally somewhere in March, and it is a framework for implementing compassionate care, and is is a practical guide for practitioners who are interested in making that shift, but might not know exactly how to do that. So feel free to reach out. I'm always happy to have questions. And yeah, let's, let's move into that.

Sara 

So the first. Question is actually mine, and it's something I think we talked about a little bit when we remember the AO presentation, but I would imagine it's so challenging as a clinician, how do you balance so the desires, preferences, autonomy of a child, versus the demands of the parents in brackets who are paying for the service or who like you should be, you know, you're working for them, essentially,

Jen Farris 

yeah. And so what I would say is, you are working for them. We are working for them. This is their life. This is their child. This is their home, okay? And so I think that that's important distinction is like we, we have to recognize them as decision makers and look at the entire scope of a person's life. Now, the challenge comes into play when you don't agree with them, right? And so I think that that's probably the spirit of the question is, what about when we're here and we're there, you're going to do your best to to find some neutral ground. But if you, if you can't, it's actually probably the best thing to say, I'm actually not your person. And that's okay. I've done that where folks want me to give them recommendations that are consistent with things I did 2009 and I say, I'm not that clinician anymore, and so if that's what you're looking for, I can refer you. And I realize that's probably a little different there than it is here, but it actually doesn't benefit anybody for two people to have very, very different opinions and be trying to provide collaboration and consistency of care. Sorry, I probably went off a little bit on a tangent there. It's not my job to convince somebody else to believe what I believe, right? It's my job to help support every learner and their family in the best way that I can, and sometimes that means that I can't, and that's okay, too.

Sara 

I love that answer. And Marie has the like the exact opposite question, which I think is so interesting. So Flourish prides itself, obviously, on being a neuro affirming clinic. We get a lot of folks now that call the clinic and they say, if you're going to recommend ABA, we don't want it. Just don't We don't want it. So you're trying to obviously change the face of ABA. That's clearly what your mission is. What do you say to those folks who are like, No, ABA is not for us?

Jen Farris 

Yeah. I mean, I think that I don't personally feel like it's my job to change the face of ABA. I do think it's my job to show up in the way that is values aligned for me every day, and this happens to be it, and I hope that, in turn, that helps shape the way people think about ABA, but I personally can't be that person, right? And so, oh man, you know a really good person for this. I actually have this book sitting on my desk. If you don't already follow Caitlin, I would highly, highly suggest you doing that. Caitlin is on a mission to change bring it closer. Jen,

Marie 

bring it closer. We can't see it. Thank you. Some of us are older than others. I

Jen Farris 

hear you Caitlin is on that mission. She is pumping out content that says, Hey, y'all, we're doing it different. But here's the thing is, you can't do that without self reflection, right? And so there is a very gentle balance. So I share my story. This is how I got here, because it's important for me to recognize my history to be able to move forward. And I would be hypocritical if I didn't do that and said, Hey, ABA, you're doing it wrong, but I've been doing it right this whole time. That's not true. And anyone who says that is actually also not true, right? And so it's not our job to convince people about whether ABA is good or bad. It is our job to put the best, most compassionate learner, centered behavior and analysis out there so that people that's what they see. And so we have some restrictions about how we can do that based up our ethics code and all of that kind of stuff. So it's not our job to convince them. It is our job to just show up in the world and do it and let that speak for itself, and put it out there in the ways that we can put it out there, but it is restrictive and so on our like Instagram, I'll use like cartoons and say, Hey, did you know that learning through play is blah blah, blah, blah, blah, blah, because I can't show our learners who are super happy, relaxed and engaged and living their best lives and begging to come to our clinic. The world doesn't see that, right? And so the more good we can do, the more that will help. Right? You can't What is it? What it i. Going to mess this up. You can't - hate can't push out hate. Only love can right? This is the same thing. We can't go back and say, Yes, ABA is good. Okay, that's your experience. By saying that, that dismisses that for somebody else. Sorry, I'm on a soapbox now, but we have to validate and we have to do different. And say, I'm so sorry that that's your experience. I have families who come to me and I say, I'm so sorry. I was like, we don't do it that way, but the only way I can tell you that is to show you you want to come in and see how we practice ABA. We have an open door policy. You can come here and see anytime you would like. But it's not our job to convince the world that ABA isn't bad, it's not bad, but let's show them what's good about

Sara 

it. I love that beautifully put. James is asking among the community ABA is often viewed very negatively, those traumatic approaches we talked about this new approach or describing sounds good, but does research in this area actually involve autistic folks to get their views

Jen Farris 

as and also, that is a problem that we have in our field, right and so, and part of that is trying to think of the best way to put it, I call it an academic cast system, because there's only ways, certain ways, that you can get in right. And so you can't do research without a university affiliation or going to an IRB, at least you can't in the States. I don't, I don't. I think it's that way everywhere. And so there is a certain level of privilege that comes with that, right? And so not everybody can do that, even as a practitioner, I can't easily do that now. I got a job with an affiliate. I literally took an adjunct faculty position simply so I could get IRB. Because I was like, we're doing some good stuff. I want that out there. And so there's not enough of it, right? We know that some of our big organizations aren't inviting in autistic voices, and so the thing I tell people is, put your money where your values are right. Support the organizations that are doing it. Don't support the organizations that aren't. And you get to decide, but there isn't enough of it. There isn't enough of it. I actually don't, don't know of any that are actively doing it, to be honest. And some of that is my own, me, just me, just not knowing. But also I can certainly say that there's not enough of it.

Marie 

I will say I saw, I just saw Henley at the Geneva conference last week, and he was one of the keynote speakers, and he spoke quite, quite a bit about he swears a lot too. He's great. He's my kind of person. And he talked a lot about the autistic voice within his presentation, and sort of people asking questions. He had quite the lineup of interested folks. It was nice. It was actually nice to see,

Jen Farris 

yeah, we actually just came from the same conference where Caitlin presented, you know, just probably, maybe a couple of weeks before that. And so I think some of that is probably fresh in his mind as well. We had some good conversation. There was definitely some good conversation at that conference about, like, okay, you know, how do we do that? And also, kudos to him. He's, excuse me, wonderful disseminating the information, and so I think it's really helping a lot of people are hearing him and wanting to change. And, you know, I think that that's, that's what it takes, is is, and also a lot of self reflection to be able to change. You have to be able to acknowledge what you did and you don't want to do again.

Sara 

And James has one more question, and I think that's a good one. We can probably end it there. But as a primary care provider, if I want to suggest treatment for a patient, how do I tell if an ABA provider has sort of more of this forward looking compassionate care approach or antiquated approach, like, do you guys have a club or something. Is there a website where we could find you? What are?

Jen Farris 

I wish there was a website where you could find us. We do have a club. Probably not in the not in the traditional sense. But I think that those of us who know the other one who's doing it, we kind of hang together, I think, because we, you know, we'd always make friends with everybody. And so that can be tricky. So ask a lot of values based questions. And so we do this in our interview process, and we ask folks, one of the big questions that I ask BCD is, when I'm interviewing them, and I know this isn't exactly the same is, what did you do previously in your practice that you don't do anymore? And why? And if somebody can't answer that for me, I know they're not the right person for my organization, because you have to be able to engage in a level of self reflection to be to engage in neurodiverse practice, right? It's not about you, it's about somebody else. How are you showing up? How is it impacting and so what I would say is, and I've thought about, I can't do this as a an agency owner, but I would love for a list to get out there of what parents and families and caregivers and practitioners and primary care providers, whatever it is want to tell parents to ask now, again, I can't do that. I mean, maybe I can. I'm obviously biased, so I would have to disclose that bias. But, you know, I think it's about what? How do you center trauma as a part of treatment? Do you practice trauma informed care, if so how? If somebody can't answer how they're not doing it. What is your current approach to treating complex behaviors? That is a big one, that you will learn what somebody is doing and so ask them vague kind of questions where you know it's not you can't ask them poignantly, right? Because they're going to tell you, I've had this happen. They just tell me, Oh yeah, well, we use assent based practice. Great. How does that look? Well, you know, we honor sent an assent, withdrawal. Okay, well, you don't know the definitions of those if you can't say anything beyond that, right? And so I think that's where you have to look, think about the questions and dig into their answers a little bit, because genuine, like, generally, when you ask two or three follow up questions, you'll be able to weed out the folks who really kind of don't know what they're talking about, or just kind of giving you, like a stock answer that they think you want to hear, versus people who genuinely do that in their practice, someone who genuinely does it, like I could say, right? I said to a parent yesterday, cool. She's like, I was like, No, but I read this article, and this how you want me to send them over to you, and they literally live in my Dropbox, and I could send them right now. If you can't send them right now, you don't do it, because if you do it, you have the resources readily available to be able to access,

Sara 

Jen, we are going to wait for you to write that list of questions and just letting you know we don't mind your bias, and we think it would be incredible as a resource. When you're not dealing with your three boy practice. Please send us that list, because I think it would be incredibly valuable as a resource, to be able to hand to parents and say, if you're going down the ABA Road, these are the questions that it would be prudent to ask. And I love that thing from an ABA. I think it's the most important. You were delightful and such a beautiful thank you for joining us. Thank you everyone for hanging out with us on your lunch break. We appreciate you showing up. Tune in next week so doctors, Michelle Foster and Nina Mafrici are going to be talking about treating eating disorders essentials for clinicians. So join us for that. Jen, thank you as always, and we know how to get in touch with there's follow up questions. And we are very much looking forward to that whenever you get around to. Thanks Jen

Jen Farris 

I'm going to work on it. I wrote it down. I have two close colleagues who also practice the way that I practice and own clinics. So we're going to put a list of questions together and put out there for you guys.

Sara 

I think that would be so incredibly valuable. We appreciate you so much, yeah,

Jen Farris 

thank you so much.