Text Transcript: Linda A. LeBlanc, PH.D., BCBA-D

So welcome back everybody.

I'm delighted this morning to introduce our first guest speaker of the day Dr. Linda LeBlanc who is who has the PHD she is a board-certified behavior analyst doctorate also a licensed psychologist Dr. Leblanc president of Leblanc Behavioral Consulting and the current Editor in Chief of the Journal of Applied Behavior Analysis her 25 year career has included academic positions at Claremont McKenna College Western, Michigan University and Auburn University as well as leadership positions in human services organizations.

She established LeBlanc behavioral Consulting in 2017 and consults to technology companies universities and behavior analytic Human Service organizations.

Her research interests include behavioral treatment of autism Technology based behavioral interventions supervision and mentorship Leadership systems development in human services.

Dr. LeBlanc is a fellow of The Association for Behavior Analysis International abai, and is the 2016 recipient of the APA Nathan hserne award for distinguished contribution in applied Behavior Analysis during her presentation, Dr. LeBlanc will allow questions in the chat or you can raise your hand and ask your questions.

With no further Ado, please welcome Dr. LeBlanc Thank you so much.

I love presenting and interacting with my Canadian colleagues because you say my name just right which is wonderful.

Thank you so much.

Thank you so much for having me.

Let's get my screen share.

And what I'm gonna be talking about today is um the idea of Compassionate Care and building therapeutic relationships.

Not only with the students that we serve but with their families and extended communities and the reason that is not my picture but instead is Bridget Taylor's picture is that she and I really have worked together not only on the research that we've done that we are building.

So special thanks to Bridget Taylor who created this presentation with me and who has also given this presentation in other places.

So we're going to talk about today is this idea of Compassionate Care and the effects that that can have on student outcomes and also the experiences of families.

We're going to talk about the idea of Compassionate Care in applied Behavior Analysis services.

We'll talk about some basic skills for enhancing therapeutic relationships.

This will not be an extensive treatment of each skill, but I do want to let you know that Dr. Taylor and I are actually creating a much larger CE series that's designed to teach many of those skills.

That should be available sometime next year.

We'll talk a little bit about how you can supervise and teach others to develop these skills.

And then finally, we'll talk a little bit about how we can extend that idea of compassion.

To our own self-care so that we're able to keep doing the very hard but good work that we are assigned to do every day.

So let's talk a little bit about some of the findings from Healthcare on the effects and the impact of Compassionate Care.

This idea of Compassionate Care not just serving people well and doing the right procedures.

But in fact building relationships with them.

Has been very prevalent particularly in healthcare and medical research and I think one of the reasons is that it was not always the case that doctors had fantastic relationship building skills, and it was noticed that that in fact could have a detrimental effect on the care that patients received.

So there have been multiple studies that have shown that there are these characteristics?

of physician interpersonal Behavior Their empathy kindness they're listening skills.

and that these characteristics actually produce a very positive effect on the patient experience that is The patients less anxious and so communicates more effectively and Report higher satisfaction with their physical care.

Which is great.

We certainly I think all hope that we have better experiences with our own Healthcare.

We don't want to dread going to the doctor or feel like we can't communicate about what's wrong with us.

in a way that leads to effective services but that's not the only thing that we would like to see actually get better.

So that say those same characteristics of empathy kindness communication skills.

Have also been examined to determine whether there's a better effect or outcome.

That is if your physician is more personable communicates more effectively and in some way.

Conveys that they care about your Wellness.

Are you more likely to actually adhere to the treatment recommendations that are provided?

And does that then lead to improve health outcomes?

And in fact, that's also been demonstrated.

We not only like our patient care better.

We benefit more from it.

The quality of the relationship of that provider has also been associated with improved adherence to treatment.

and improved Healthcare Health outcomes in areas such as diabetes HIV Asthma Etc.

so that notion of compassionate empathetic care and taking care of the relationship with the patient as well as giving the checklist of things to do can increase the quality of the patient experience outcomes, but it also has been shown to have beneficial effects for the provider themselves.

That is nurses Physicians and other healthcare workers Who have stressful jobs and high rates of burnout?

Actually experience their job differently when they are taking that time to connect with their patients and be empathetic and compassionate.

This has been shown in several studies.

In fact, sorry about that.

Um, they generally experience less stress.

Experience less burnout have less absenteeism that is calling out sick or and lower turnover rates when the physician is more compassionate.

So if you are thinking about the extent to which You also have a stressful job.

I'll bet you do and it's interesting that as we become more stressed what often feels like.

Is hard is some of the calmness kindness and empathy that said when we can redouble our efforts in this area, that's often what leads to longevity?

These effects have been so robustly demonstrated that every medical school in North America now has a communication skills course.

So that Physicians must learn how to communicate more effectively and more empathetically with their patients.

So now let's think a little bit about our own backyard.

And I'm going to be talking about ABA treatment services for autism spectrum disorders, but your own backyard might include a variety of disciplines such as speech language pathology occupational therapy physical therapy.

The wall pretty be presenting literature from ABA please think about is there literature in your discipline.

If it differs that would suggest you have some room to grow or some room to share what you already know with your colleagues.

In fact this area of relationships and relationship building.

Is an area where perhaps we have struggled?

And it's notable.

so notable that I think there have been multiple published articles and books recently that have really emphasized that we absolutely must.

Take advantage of the opportunity to build relationships and use these skills and then if we fail to do so.

We may lose the opportunity to influence and collaborate with others.

Those who are not.

we might use the word personable meaning they are friendly they are perceived as kind caring and If you're not personable, you might risk losing career opportunities, perhaps a job perhaps a promotion.

And most importantly what you might lose is the opportunity to influence others.

now when we think About our clients our students.

You might think about well, who do we need to influence?

Of course, we need to influence others on our multidisciplinary teams.

We need to influence our school administrators.

We need to influence our students and in many ways.

We also need to influence their families because any time they are not with us.

They're with their families and the long-term goal certainly for ABA Services should not be just to Influence the client but instead to strengthen that family unit as a means to transform that client or students life.

So these skills are important.

They're quite important.

and there are some core communication skills that our teachable.

And effective Communicator knows when to initiate the communication not interrupting not delaying too long not pushing when there is emotion being experienced by the other person.

They also know the impact that they hope to have on the recipient.

I think that's one.

We sometimes don't think through is fully as we could.

We are simply behaving and interacting.

And if someone were to ask you to describe.

What impact you hope to have?

Well, if you were talking with your students, you might hope to have the impact of teaching them something you might also hope to have the impact of being interesting and engaging you could have both of those impacts or maybe just one or the other you could be interesting and engaging and they don't learn anything.

You could all see manage to teach them something but not be perceived as particularly enjoyable in the experience.

So when we can actually Describe the impact or impacts plural that we hope to have we increase the likelihood that we might have all of those impacts.

An effective Communicator also knows which strategies are likely to achieve the desired impact.

And which behaviors of The Listener indicate whether the intent intended impact as occurred?

If part of your intended impact is that the person is engaged and enjoy the interaction with you then you're going to be looking for them to be making eye contact or looking at the materials relevant to what you're teaching you might hope to see Some Smiles some indications of affect that suggests.

This is fun.

Or at least I'm reasonably glad to be here.

Now speaking specifically about applied Behavior Analysis.

There is nowhere in our task list that says provide effective Compassionate Care.

That said there are lots of items in the bacb task list.

That are directly relevant to the things we do when we take care of relationships and and build upon those compassionate actions.

For example, being able to explain behavioral Concepts using non-technical language means that you are paying attention to the listener when you communicate is the speaker.

In doing so you have to kind of understand that perspective of The Listener and care enough to change how you talk.

collaborating with others and selecting our intervention strategies based on client preferences and the supporting environments whether it's the classroom or the home environment that speaks to an understanding of what those environments and preferences are.

and that's part of being compassionate and understanding how much the individual and their environment family classroom matter to the effectiveness of your interventions.

Other items in our task was that speak to this notion of Compassionate Care are the notion of social validity how valuable the the things you're working on and the interventions that you're using in the outcomes you're producing.

Field to the people who are experiencing the services.

So those kinds of items are embedded throughout the task list, and I think they speak to how much.

Relationships matter in our delivery of Behavioral Services and in fact this matters much more than you might think.

The collaborative therapeutic relationship that you build with the client and the family is critical to success.

And that success shows up in lots of different ways.

It could be satisfaction with the services.

adherence to the services transparency and real understanding perhaps even pursuing the services being willing to accept a certain placement in an educational system or seeking additional ABA Services outside of the school system.

So all of these things are heavily influenced by the quality of the relationship.

This is an article published a few years ago now before the pandemic so it kind of feels like both yesterday and a hundred years ago.

But what they did in this study was they?

Basically created a choice situation for families of children with autism spectrum disorders and the choice was fatigue between a treatment.

That would be a certain percentage successful.

And a therapist or bcba or therapeutic agent with certain characteristics, like being cold and distant or warm and accepting.

and in fact, so what they were looking at is How willing would you be to accept a less effective treatment?

If the person is nice as opposed to cold and distant and in fact parents were willing to tolerate a treatment with significantly less empirical support and Effectiveness in favor of therapeutic relationship variables.

In fact that breaking point was somewhere in the 30 to 40% likelihood of Effectiveness, you might think it would be even higher so When we don't take care of these relationships and The Impressions that we have on other people there was a real risk that they may.

Choose different kinds of services choose no services at all and we don't want to put families in the situation where they have to choose between Effectiveness for their child or a reasonable experience for their family.

So there I think are some real risks if we don't build relationships in our Behavioral Services delivery whether it is in a school setting or in a more private setting some of the you know, I think what we imagine is that families have all of these different stressors strains worries.

Um, some grief potentially associated with some life that they imagined having before they found out that one of their children had an autism spectrum disorder and I think we imagined that ABA Services Educational Services Etc is a counterbalance to that.

We absolutely want it to be it is intended to be But we have to ask the question of whether it really is or whether that box is actually piling up on the other side of the teeter-totter and adding to the stress.

If we don't pay attention to the relationships and build the relationships families might choose and effective treatments because other providers have skills in this area families might disengage from services and that could lead to a squandered opportunity to Help them with things that they're unwilling to bring up.

So.

when you build relationships with families, they're more like to likely to mention how some of these other things like sleep problems like going out in public really negatively affect their lives, which gives you the opportunity to potentially help with those things without that relationship and that willingness to communicate that information is lost.

so that we don't have the same opportunity to help that we might otherwise have so let me now focus on how do we think we're doing in building compassionate and empathetic relationships with families.

Again, I'll speak specifically about ABA Services here are two studies that Dr.

Taylor and I recently co-authored with Melissa nosek.

and Nancy Marchese these two articles first found out from caregivers how they think we're doing and then found out from Behavior analysts the extent to which they'd actually been trained in these skills that we are suggesting or so important.

Let's focus first on the survey that we did with parents of children with autism.

In this survey, we asked parents of children with autism who had received ABA services.

About a variety of different behaviors that the behavior analysts might have exhibited.

In the area of compassion and empathy listening and collaboration.

And behaviors that might contribute to problems in the relationships.

Let's focus first on empathy and compassion and what we found was that there were several things that behavior unless were perceived as doing quite well.

So for example acknowledging and celebrating the child's accomplishments was a real area of strength.

And in addition demonstrating care about the child was another area of strength.

Now that may not be surprising because we're an education and Human Services we wouldn't be here.

If we didn't care about these wonderful children students that were fortunate enough to serve and if we weren't excited about the things that they are perhaps able to do now that they couldn't do before.

So I have been in this field and operating in a variety of settings including school-based settings for decades and that notion of really focusing on the child's strengths as a means to not only enhance their educational experience.

But to reflect their humanity is something that we have been talking about for decades.

The great news is in fact, this is occurring.

So we have heard the beat of that drone.

And in fact, this is where we are really shining that said there were some items that were scored lower.

Now, I will say this all of these items were kind of scored on average in the Middle Ground rather than bottom of the barrel but keep in mind there may well be a positive response bias for some of these so these are the ones that we could still use a little work on.

Regularly checking in with the parents about how the parent is doing.

So that notion of if you don't think of the entire family as connected and important and the appropriate context for the relationship.

You may not think to ask about this.

Acknowledging mistakes when they're made that was an area that was not scored particularly, highly.

And reassuring parents that things will get better.

And having an understanding of what it's like for parents.

So these are areas that all matter with respect to someone perceiving you as empathetic and compassionate and having an understanding of what they're going through.

Let's talk a little bit about some of our findings with respect to listening and collaboration.

Hopefully we're all continually receiving training and practicing these skill sets.

They're considered.

Are critical part of our teaming skills and part of what we have to do is think about teaming with families.

Here's what's going really well.

In particular Behavior illness we're perceived as listening to concerns during first meetings.

The equivalent in an educational setting might be that beginning of the year meeting or IEP.

protecting confidentiality and considering parent input which is wonderful.

collaborating on goals But there are some areas that were scored again more in that mid-range.

This is the area where we need to continue to focus on supporting people to do a little bit more of each of these.

Directly asking if the parent is happy with how things are going.

It could be that we don't think of it.

It could also be that if we think it might not be going.

Well, we don't want to hear about it.

But of course that's exactly the time when we need to hear about it.

compromising when there is a disagreement that was rated relatively lower meaning that there is less perceived compromise occurring Clarifying the expectations of both parties including what the family or parents can expect of us as professionals.

And when regularly communicating about changes in programs.

Are also some behaviors that we asked about.

In terms of these are behaviors that if they occur might actually interfere with or damage that relationship or Therapeutic Alliance.

So, um some of the ones that were endorsed, um, we're having their own agenda.

That is the professional the educator can be perceived as having their own agenda for what needs to happen.

And if that's the case it can in fact Kind of convey that that agenda if it differs from that of the family is the more important one as opposed to the families agenda for where they need help and support.

Best of all a collaborative agenda that incorporates both sets of goals objectives and priorities is likely the one that moves services farward.

to best effect another behavior that can in fact damage a relationship is when the family perceives the provider as underestimating their child over focusing on the things that they can't do.

Of course, it makes perfect sense that are provider educator would focus on the things that they really want to be able to teach but if That environment therapeutic environment educational environment for some reason is not bringing out the best effort of the child.

The family may see that the child actually can do some things that they're not doing in that environment and it may lead to the provider underestimating what the child can do and not actually require them to give their best effort.

Over focus on challenging Behavior as opposed to some of the skills that the family may be hoping the child can acquire can somewhat damage relationships.

Poor communication.

Oops is a fourth one that was endorsed as some of the more common things that these families had experienced that providers did that might limit the therapeutic relationship.

Here is a direct quote from one parent who responded to our survey.

Now.

This doesn't mean every parent has this experience, but what you may find in in reading this is that it resonates, maybe not about the teacher.

Maybe it's about the the obsession object toy whale in fact, there's a book out there called just give him the whale This parent reported that their son's first therapist was a young woman with no kids now that in fact is not necessarily what makes you knowledgeable in your discipline, but it does influence appearance perception.

the notion of understanding that you got to pick your battles and this therapist really wanted the battle to be about not wearing t-shirts with trains on them perhaps it was considered not age appropriate or not environment appropriate probably all of us have some story about you know, some Behavior or preferred object that kind of Seemed contextually at odds with either the age of the client or student or what have you.

well This is the battle that that therapist wanted to fight.

The parents disagreed about the importance of this battle.

and in fact We're willing to let the child wear those t-shirts because it makes him happy but let's focus on these other things instead.

One of the things to keep in mind is and it is always true.

the therapist Is temporary and discretionary in the life of the family?

that is they can leave.

We are at least in ABA Services outside of educational settings.

We are privileged to have the opportunity.

for some amount of time to work with a client and their family and if we behave in ways that lead families to feel like we are focused on things that are not valuable and valid to them.

We may be shown the door now in Educational Services.

Generally, the child will remain in Educational Services, but certainly there can be a tougher year than there might otherwise be if those relationships get damaged.

Now what I am not saying is whether it is right or wrong to have to discuss the issue of whether a child wears only shirts with trains on them and what effect that might have on their life, but the notion that there was combativeness between this family and provider.

And really, you know pushing on something that the family didn't value in a way that felt pushy rather than supportive and collaborative shows where the damage to the relationship might lie.

Let me pause there just for a moment and open it up to chat questions participation anything like that.

How are we doing?

Um, Monette and Shelley?

Hi Linda, Shelley.

I'm not seeing any questions in the chat right now.

Okay, certainly if any oops wait, hang on there is one.

More a comment I guess okay question.

Yeah, one of the participants is saying pick your battles a hundred times that she says pick your battles 100 times a day.

So very important to make that part of our repertoire.

Yes, indeed and to realize that sometimes we're not only picking our battles.

We're trying to pick the families battles and and understanding that they are also in that same position.

I think is the critical part.

All right.

Well, we'll move on then and we'll talk a little bit about.

How we are training?

I'm our new professionals again.

I'll be speaking about Behavior Analysis.

But if you're discipline is different think a little bit about your graduate training experiences.

if we see that We're not wildly succeeding at something.

Then we have to always assume that we may not have effectively trained people in those skills.

You know I am.

a big believer that those of us who commit our professional lives to education to Allied disciplines.

We care we care tremendously and we care about our success.

And so when we're behaving in a way that is not resonating.

There is often a likelihood that it's because some part of our graduate training did not fully Embrace a skill that we actually need.

So perhaps you've had that experience we often have it like in the first year or two or three after we're done with our graduate training where something occurs and we think I did not learn about this and graduate school.

And in fact, we might have those experiences for years.

so there was an article published by Pastrana at all.

And that looked at the assigned readings in Behavior Analysis graduate training programs.

And then our article looked at the experiences of behavior analysts by serving directly the behavior analysts about whether they had had any training in Compassionate Care and therapeutic relationships with caregivers.

In fact that article on the assigned readings found there was not a single.

Commonly assigned reading in graduate programs that focused on these skills of building therapeutic relationships with families.

And when we surveyed our Behavior analysts we had 225 respondents.

And 82% said that they either sometimes are often feel unprepared to deal with the expressions of emotions that they encounter from parents.

particularly, I think when parents are early in that period of diagnosis maybe within the first year or even two years from identification.

They are adjusting to a world and a way of thinking about their family and their future that is different than before their child was diagnosed.

That can engender lots of emotions and ongoing life with all of those stressors that we talked about on the teeter-totter can also engender lots of emotion.

If we aren't prepared.

To deal with that in the moment in a therapeutic way.

It means that we are not preparing young Professionals for what it is.

Very reasonable to expect might happen.

The majority of our respondents indicated they had not had formal training in these skills either in didactic classes or in their practica.

About half said that these kinds of skills were addressed in their mentored experiences.

I would suggest that these kinds of skills.

If you are going to be a professional behavior analyst practicing in school systems in early intervention and private sector.

These are critical skills that every single person should have training in.

94% of our respondents said their colleagues struggle with these skills.

Here's one.

Response for to our surveying emotional Detachment is promoted in graduate training to prevent individuals from Crossing professional personal boundary lines.

Basically, not establishing a multiple relationship.

But particularly if you are doing in-home ABA Services you are in the family's home.

You're intimately involved in a lot of aspects of their life.

Certainly you at least have some visibility to it.

And you experience things like births deaths adversity and this person felt like at times certain peers in their field have handled these things robotically or not naturally because of that emotional detachment.

So what I always say is this.

Having a healthy therapeutic relationship with the individuals that you are serving is not a multiple relationship.

It is a singular robust relationship.

that includes the things that allow you to identify the things that are important to that family unit.

And to talk about things in a way that positively impact people's lives not a multiple relationship.

So one of the things that I think is critical this is always been an interest of mine, but it's really critical to this notion of building a therapeutic relationship.

So we begin to talk a little bit about what are these skills that I'm going on and on about being so important one of the ones that I think is most critical or perspective taking skills.

Here are a couple of quotes and I should have mentioned this before but when you see a green quote box like this, that means that the source is a book that I've recently written on supervision and mentoring and with my co-authors Dr.

Tyra Sellers and Shala alai.

So there aren't citations on each one.

But anytime it's in a green box.

It's from that book.

Perspective perspective taking is predicated on the notion that anytime you're interacting with someone.

You are going to be more successful if you assume.

that their responses their view of the world is understandable and predictable if you see the world from their perspective.

Even if they're angry with you and you're not sure why.

Something about their circumstances their experiences makes it reasonable to them that they are experiencing that anger or saying what they're saying or doing what they're doing.

It can be hard when we get into a situation where we disagree on things to fully.

Step back and take the other person's perspective and sometimes to assume the experience.

This person is having the the anger the Outburst might have very little to do with us and more to do with what they are experiencing in the moment.

I think this is true of all of us whether we're in a multidisciplinary team meeting or we are in a family or a parent meeting or we're in a classroom with multiple students.

We should always assume that the other person's circumstances.

If it seems surprising to us, their circumstances aren't fully known.

But that if we did know what they were experiencing at that moment how they felt what had happened the day before the night before Etc.

we could perhaps understand why their behaving the way they do.

With our students.

This is the underlying value of a functional analysis problem Behavior, maybe making our lives difficult, but the student is not engaging in problem Behavior to make our lives difficult that just also happens to be happening.

There is a reason from their perspective.

Why this behavior is occurring there are motivations and there are contingencies and experiences that are supporting that behavior.

Even if it also happens to be disruptive to us.

Well, the same thing is true in any of our interactions.

When that guides our behavior in every interaction, we are more likely to take that Pawns.

And think about what might be happening.

and what is my desired impact in this interaction in this communication?

Such that we're able to communicate in a way that achieves that desired impact.

another I think of it as a golden rule in in our personal situations whether it is with a colleague a student families.

Being right should never be the goal.

Being effective should be the goal.

And I think we've all encountered people that got a little too caught up in being right or being the boss of that situation.

And as a result, they were less effective than they could have been with the people that they were interacting with and if we take a moment of honesty, we can probably all identify a situation in which we did the same thing.

We became more vested in being right.

Which often engenders the other person being wrong then being effective and coming to a point of discussion collaboration compromise?

If you are in a position where you can look back on your career your personal life wherever it might be and recognize that those things have occurred at some point in the past.

That's suggests you're healthy because if you look back and say no there ever haven't ever been any of those.

It means that you perhaps don't have perspective on some of your own behavior.

None of us are perfect.

We're all human.

We you know exist in cultures where it's kind of good to be right that gets established as valuable.

So it means that as a provider a therapeutic provider and educational provider, we have to recognize that there are these motivations that influence us every day and we have to overcome them.

We have to be noticing in mindful of them.

and remember being right is not the goal.

Big effective is the goal.

I don't have to be right and convince this family that there will be no more trained t-shirts.

I have to be effective a communicating with this family about what they want their child's future to be and the fact that at some point it would be great.

If there was a a set of guidelines right for going into other public settings or for having lots of things that their child liked and enjoy that made them happy.

oops So I want to make a distinction between the term sympathy and empathy both of them require perspective taking some understanding of the other person's circumstances.

but sympathy is basically recognizing what a person might be experiencing and feeling for them a little bit.

empathy more fully Embraces that idea of perspective taking and a true walking in someone else's shoes in a way that leads you to want to make their situation better.

sympathy is often kind of I mean it's better to be sympathetic than not sympathetic.

But sympathy in and of itself can often feel like pity and is sometimes not preferred by our clients.

Our family is what have you but empathy I understand how hard this is and I want to be here to help you with that.

Is often perceived positively and is a game changer in working with our our clients our students and our family.

So when we Endeavor to understand the family's perspective what they're going through what they value what they have the time and energy for we actually are engaging in perspective taking and fully embracing empathy.

When we change our Behavior.

To address what is causing that family distress then we've moved into the area of compassion.

that is Understanding of the variables that produce the distress but more than just understanding it and observing it actually actively trying to do something to alleviate the distress.

And here's the thing.

We're not always able to change the situation that is causing the distress.

So it means sometimes what we do to alleviate the distress is to be there for that person.

To communicate that we understand.

That we care.

And that will continue to support.

Even if we can't ultimately solve the thing that's causing the distress.

So when we think about perspective taking You might think like why are we even talking about this?

You know, this is something we actually teach our students with autism when they are six seven eight nine.

In fact, our our clients and students with autism typically have great difficulties with perspective taking for many of us.

This is something that comes as part of our typical social emotional development.

but for those Autistics they have tremendous difficulty with us.

Sometimes it has to be actively taught that another person might see feel think and no different things than you do and they're going to behave based on what they see think and feel not what you see think and feel That discrimination between my experience of the world and their experience of the world can be confusing really even baffling to our clients and students.

But in fact, it comes all the way back around to our experience as a provider.

Or an educator.

So one of the things that I have done throughout my career as a professor training people and also as the executive director of a large Human Service Agency is helping people understand how they with best intention might be absorbed in their own perspective.

And it limits their ability to take the perspective of the other party.

Assume that families might be anchored in their own perspectives.

So tightly that they do not appreciate the provider perspective, but that's okay because that's not their job.

As the provider as the professional it is our job.

To engage in that perspective taking to have empathy and then to behave in a way that furthers the conversation.

So let's take a look at their family perspective.

From the family perspective.

My child is the most important person in the world.

Now, it could be that their child is one of 12 children in your classroom.

And of course they are equally as important as the other 11 children, it is a different perspective to view that particular child as the most important person in the world.

The family might also think what my other children need me to I can't do all of these other extra things that take all of my time for only this one child.

Maybe I just need an hour to myself or my head is going to explode maybe the family perspective is my child needs to participate in all different kinds of therapies.

And part of it is I have to try absolutely everything because I couldn't live with myself if I didn't try something that perhaps might help.

Or from the family perspective.

I don't want to see my child struggle or get upset in sessions.

I need to make him feel better right now.

And I need to let him wear the T-shirt with trains on it because it makes him happy right now.

Now there's no right or wrong to this description of perspective, but it is what a family might experience as their reality.

If we take a look at a providers perspective.

Yes, your child is important but is one of my many cases or students and your child will get the very best circumstances.

We can provide the very best Services.

We can provide under the existing circumstances perhaps there are many staff who provide services and of course the family wants only the singular best one every single time with their child.

But all the children have to have services and someone is going to be assigned to that best one and it's going to vary over time.

And perhaps the provider thinks we're delivering high quality services and the literature suggest that the time put into this is more likely to have a payoff than some complementary and alternative medicine approaches.

So maybe the provider also sees these opportunities where we need to push your child to best facilitate progress, maybe work on teaching them to tolerate some of those situations where it is a little different this time or there is a different T-shirt to wear or whatever it is that is being requested can come after a delay.

Or that we care about the families that we serve but it's a professional relationship and we need to maintain boundaries.

This perspective may sound very familiar and reasonable to everyone in this training and it is reasonable and likely familiar.

the important thing to keep in mind is that neither perspective is right or wrong.

They are simply the perspective of two different people.

So your greatest.

Vantage point for being able to foster a healthy relationship comes when you can step back.

And see both of these perspectives and recognize the ways in which we pull these people gently closer together.

Now, let's say you are the provider and I am typically in that position.

Then it means you have to step away from your own perspective far enough to be able to recognize that these tenants that you hold to be true.

So closely that you might not even.

Recognize that you hold them until you see them written now.

They are your worldview, but they are not everyone's worldview.

And the fact that they are your worldview doesn't mean that everyone else should agree with that worldview.

We should expect that people have their own different perspectives.

pressure demands and needs When you can engage in that perspective taking and recognized yes, these other statements are reasonable and accurate and or at least accurate from your perspective, then you've really come to understand that other person's circumstances in a way that's gonna allow you to connect with them meaning pulling.

so when we think about perspective taking what we want to recognize is that if we engage in perspective taking versus not it changes.

How you communicate?

How you problem solve?

How you make decisions?

How you interact with the family or other school professionals?

Part of what it does is it may lead you to realize that there is more than one impact that you need to have with your communication.

And then honor those multiple impacts that yes, you need to convey the value of this thing you're recommending, but you also need to convey that you understand or that you care about coming to understand some of those other variables that the family may be experiencing.

When you engage in that perspective taking it helps you realize you need to create and have other impacts which then may make you more capable of actually having those impacts.

When you engage in perspective taking it also can impact how you problem solve.

So it might lead you to say, okay.

Maybe this thing that I see is the most important problem doesn't feel like the most important problem.

We're gonna decide not to even solve it.

We're not going to fight the train t-shirt battle or whatever it is.

It may also if you jointly decide yes, this really is a problem may lead you to ask questions that give you a better understanding of what the family's context and resources are so that you recognize whether this solution really is possible or maybe not possible and then you identify strategies that might be able to work a little more effectively.

That can lead you to make very different decisions.

And perhaps to contextualize your your teaching procedures and your interventions and even your goals.

In ways that are more valuable for the family.

Okay.

I'm going to Pause sharing and say it's time to take a break and Shelly or Monette.

Do we take a five minute break a 10 minute break.

What do you typically give?

Hi Linda, it's Shelly.

Let's say we're at 11:05 here in most of Atlanta Canada.

11:35 in Newfoundland.

So let's say maybe a 10 minute break and then we will come back at 11:15.

That sounds perfect.

I'll see every and we all stay in the zoom, right?

Yes, and okay exactly you at 11:15.

All right.

Thanks so much.

Hi Linda, Shelley again.

And I just before we started back up.

Just wanted to let folks know that for participants who are looking for bacb continuing education.

I just put the verification code in the chat so you can take a look there.

The code is 2 4 7 8 2 so go ahead and fill that in on your ceu form and we can go ahead and get started whenever you're ready.

Wonderful.

So we've talked about perspective taking and empathy and let's talk a little bit about this idea of compassion.

That means We're moved by the experience at the other person is having and we are motivated to leave some of that distress or suffering there were comments in the chat about.

You know when we sometimes have conversations with parents and it leads to them becoming emotional crying.

Sharing with us about their experience.

They are suffering in some way and being able to recognize their suffering in a non-judgmental way not I wish they weren't behaving this way right now.

But this is what they feel is a core part of that and this is important.

They're suffering does not have to become our suffering.

It doesn't do anyone any good if we fully take on that emotional burden that the family is experiencing it we Should draw upon the universality of suffering and Human Experience to have some kind of understanding of what they are feeling.

But we're not in their circumstances.

We're not in their shoes.

It is not our life family and circumstances.

We should Endeavor to understand it and we will almost always be moved by that experience and the fact that we've connected with it.

What we draw on to be able to understand their feelings is often not an identical experience.

You don't have to have gone through exactly the same thing.

To appreciate how hard it must be.

For someone to be going through that thing.

and we have to be able to tolerate those uncomfortable feelings that are aroused fear distress sadness when we open up to and remain open to the experience of those families have So if our situation is well when I ask about how it's going for you you're sad you cry you and I don't want to experience that.

We'll stop asking our behavior of asking gets punished.

If we can tolerate right work on some of our own distress tolerance to be able to tolerate.

Experiencing that other person's emotion so that they are able to express themselves and have their distress lessen some by the fact that they could connect with another person about that.

Then we have behaved compassionately.

So compassion is behavior.

It's the things you do every day that might.

Connect with and alleviate the suffering that someone else is experiencing.

So I mentioned the green boxes were from a book.

This is an image of that book and what I'm gonna be talking about in terms of specifically how you might teach these specific skills is covered in a chapter of this book chapter 9 on interpersonal and therapeutic relationship skills.

So if any of this seems interesting to you and you're wondering like, how can I get access to some of these tools and activities and curricula that she's going to show this is where you would find it.

You also can find some of the information in this article that I corrode with Dr.

Bridget Taylor.

If we believe it's reasonable to expect all professionals to have some of these skills.

Then we have to begin to actively teach and coach these skills for some of us.

It's a little bit more natural and intuitive for some of us we've had some training but we wouldn't want to leave anyone without the resources to help them be compassionate without being utterly overwhelmed by what it's like to feel a semblance of what the person that you are supporting feels.

So in that article and in the chapter, what we do is we lay out the skills that we think it's appropriate to teach.

The skills to Monitor and then Target for change some of the activities that you can do to help teach these skills and the value would have metrics you can use to determine whether you're having any good effect.

There are also some Source some resources for you.

So the first area that we focus on is just engaging and positive social interactions.

These are those basic.

Interpersonal skills in any interaction some of us do better at these than others.

There are certain times when each of us does better than others.

Smiling and knowledge the person making eye contact making positive comments about the child's Behavior as well as the parents Behavior expression expressing appreciation for the parent.

Thank you so much for coming in today to to talk with me and what have you it's all time.

It's all effort.

providing realistic hopeful comments about the child's prognosis demonstrating General enthusiasm about the direction of the child's program that all important question of asking the Power Parent how he or she is doing clarifying roles asking the parent if she or he is happy about how things are going.

And for some of us this is certainly part of how I do it is using humor when appropriate, you know, sometimes you're talking about things that are tough that are there there's not been a lot of progress and there have been some tough experiences.

And if you can find a way to kind of introduce some subtle humor, um in no way making jokes about the child or the student or the family, but kind of that shared knowledge of we're kind of going through something a little bit tough and and it's real.

That often helps with the interpersonal engagement.

So these are skills.

It's not just a matter of maybe you're lucky and you're good at this or you're not anyone could become better at these and part of what it takes to become better at these is to notice.

If you're doing it notice how often you're smiling versus having a neutral expression when you're talking about and things like a child's progress or lack of progress or progress in certain areas, but not others.

One of the things to even mind.

Is that a neutral expression may be perceived as a negative expression.

So monitoring is my affect flat or am I looking away often because this topic feels uncomfortable.

Am I perhaps a little bit frustrated that this parent showed up 10 minutes late and I'm letting that show like my time is valuable, too.

These things are all.

things that we have to monitor and recognize that they will have an impact so we may have two three four desired impacts.

but we could also have impacts that we're not even thinking about with other Behavior if we're not monitoring all of it each of these things can be taught with role play with practice observing great exemplars, and they should all have an effect if they change not only on what you see and how skilled the person looks but How it's perceived by the parent.

So each of these things are laid out for you in this article, if you feel like this is something that I want to work hard to put into our ongoing curriculum with paraprofessionals professionals administrators.

All of these things are the building blocks of effective interpersonal interactions without them some of the other things that I'm going to discuss may fall a little more flat.

These are things that you can do every day in good times and bad that help to build the relationships.

Now, let's talk a little bit about empathy.

Well, we lay out some of the things that you'll want to teach with empathy as well making eye contact, even when it's a difficult topic, especially when it's a difficult topic actually has a differential effect.

Then I contact when it's an easy interaction.

Body posture sitting up leaning forward approach behaviors maintaining a positive to neutral facial expression.

Using a reassuring tone of voice can even have an impact and so part of what when you are working on building these skills part of what you are doing is helping the person come to understand that.

All everything about them can be a therapeutic tool their facial expression their body posture the words that they say the listening that they do nodding to indicate that you're still actively listening to the person.

Some of what is called back Channel saying?

Mm-hmm.

Yes, go on encouraging someone who's perhaps talking about something that's difficult to talk about in the presence of emotions that make it even more difficult to talk about them.

Those encouragements are a big part of how you convey to someone else that you don't just wish they would stop this and that you're tolerating it but that you actually care and empathize with the fact that it must be hard to be experiencing these things in life.

One of the things that often helps to convey empathy is when you ask open-ended questions rather than closing and questions.

So close into questions.

There's a yes/no answer.

Are you seeing Improvement in this?

Yes, no.

contrast that with the question how do you feel about any new behaviors that you're seeing at home?

That tends to convey that you have more interest and care about hearing about the experience that the other person is having pausing.

This is something that we can become uncomfortable with the Dead Space the silence.

but asking a question and then just allowing the Pawns.

for the parent to answer to think through and the important experiences that they're having or even to momentarily just be rendered silent by the emotions that they're feeling when we get to the point where we can tolerate that kind of pause and sit quietly with it.

We convey that we care about what their experiencing and we're okay being patient.

Until we can continue the communication.

Another thing that demonstrates empathy is when you compare phrase back what the parent States that's part of our active listening skills that are a critical part of empathy.

And acknowledging and naming the parents' feelings you seem a little discouraged right now.

Tell me a little more about that.

Verifying the emotional responses reasonable.

That's understandable.

I also wish we were making more progress identifying and responding to those nonverbal cues.

So if the person that you're interacting with begins to have less eye contact sad facial expressions.

It typically is not helpful to.

Ignore those and just continue on instead noticing them.

I'm noticing a change in your expression.

How are you doing?

These kinds of things require us to have the time and patience to have that experience.

In a world where we feel busy rushed have a long list of things that we need to get done.

Sometimes what most negatively impacts our ability to be empathetic is the pressure that we feel to move forward and get all the things done.

Puts us in a position to not recognize the most important thing right now is this thing is taking this time to have the experience with this family.

We also outline in this proposed curriculum a set of skills that are related to compassion.

Outlining the skills to teach the things to monitor that might be problematic like jumping to Solutions too quickly or interrupting the parents' emotional response or being defensive and that role play activities.

So with respect to this area of compassion.

What you're looking to teach is?

the ability to provide those pauses to tolerate the silence space and to provide those opportunities and questions for the parent to say how he or she is feeling And to confirm that emotional response in a non-judgmental way.

and one of the things to keep in mind is that when a person is feeling distress like we have these long histories with everyone right where it may be embarrassing to cry in front of another person or to talk about your problems.

And so you have to be actively non-judgmental because in the absence of that the person may draw on all of those past circumstances where someone has been judgmental about their emotion or about even saying out loud that they feel a loss of what they thought was going to be an easier life or whatever.

It might be.

So actively confirming the parents' emotional response in a non-judgmental way.

It is absolutely understandable that you feel this way and you are entitled to feel this way is an important part.

of being compassionate providing acknowledgments of even small things that the person has been able to do or follow through on making supportive comments and discussing how as a team you can address the parents' concerns or emotional pain.

What I found is that that when there is a team a multidisciplinary team different ones are interacting with the families.

There are some experiences that they've had with that family that have been very similar, but they're also some ones that differ a bit because each of them differs a bit and if the team can talk a little bit about how can we best support this family interact with them often it becomes an opportunity for idea and resource sharing in a way that can enhance particularly the parents experience of The entire services that are being provided.

Demonstrating some understanding of what it's like for the parent by offering supportive comments and those comments are often.

They can be predicated by caveats so to speak.

I'm not living your life, but I definitely can see and hear and feel.

And understand a little bit of how hard it might be if I were having those experiences.

And then offering actions to alleviate the parents to stress, whatever those actions might be listening.

How about if we do pause on this particular Target for a week or two?

Since this other thing is happening with some other member of your family.

Yes, that problem is not going away until we tackle it, but we can make a choice about when we tackle it.

so There's one other area that we outline collaboration.

These skills many of you may feel like you've already had lots of training on I always feel like it's a good thing to revisit and we outline what you might teach monitor the kinds of activities that you might create us teaching experiences.

But seeking the parents ideas When developing treatment in a real and meaningful way, what are the things that are most important to you.

Now that doesn't mean your expertise and ideas are not valuable or included.

They absolutely should you know, we can't expect parents to be the knowledgeable professionals, but we can expect them to be knowledgeable about what their goals and values and needs are and as someone put in the chat what that child can do in their home setting in a way that can really enhancing guide overall treatment plan or IEP and taking the time to provide those explanations and rationale for the treatment proposal or the educational targets.

Sometimes things feel so natural and intuitive to us.

Well, of course, we're going to work on this that and it may not even occur to us that there's a need for an explanation or rationale from another person's knowledge base or perspective.

There might be Asking if it's ABA Services if the treatment recommendation is acceptable and what obstacles the family thinks there might be that would prevent treatment or full treatment or consistent responding.

And what is it?

You know, one of the questions I often ask is what is it?

That might make it hard for you to do this day in day out and then we begin.

To brainstorm around.

Okay.

Well, how could we make that easier?

How could we plan for those tough moments and get another resource in there?

Acknowledging the parents' concerns because when a when when a family is describing to you that something is going to be hard because of X Y and Z it is seldom useful.

To just want them to push through anyway.

Only Solution maybe you have to push through a little bit, but but It is usually going to enhance the process a little more if you acknowledge.

That really is an obstacle and maybe compromise on when or how you do things being flexible or identifying additional supplemental strategies that could help to overcome those barriers.

I think one of the most powerful things that you can do is to acknowledge your own mistakes when it's appropriate.

Maybe you tried to teach something thought it was going to be a great goal when there wasn't a prerequisite whatever it might be.

That you tried to do that didn't go well.

It can feel high stakes.

To admit that you were wrong and I always say yes, the stakes are high but it is not risk.

It is reward that you typically can get I am never seen Damage Done by saying.

You know, I just want to acknowledge.

When I chose this or wrote This what I thought was going to happen was X Y and Z and that's not what happened.

I was wrong.

It didn't turn out the way.

I thought it would let's get back on the right track.

I am not found that kind of really healthy vulnerability to ever damage how someone thinks of me.

In fact, it almost always enhances because if it wasn't working it's obvious.

It wasn't working.

It's not like you're revealing the deep dark secret.

You're acknowledging something in a way that suggests.

You're a good human and that you take responsibility for your actions.

Apologies are actually free don't cost a penny and when appropriate leading with those I'm so sorry that I didn't ask about this before I didn't have the right understanding of what this is like for your family.

So I appreciate you bringing it up now.

Can you tell me more about it?

There is no harm to be done to the relationship.

There could be harmed under your ego.

But again, the important thing is not being right.

The important thing is being effective and adjusting our Educational Services or treatment based on.

Whatever it is about that family's culture religion lifestyle values that we've come to identify as important.

So, um, all of those are the kinds of things that we need to be actively teaching people to do.

And in fact Bridget Taylor and I have felt it important enough that after we laid out the curriculum hoping that others would adopt it and start teaching these things we decided it would be reasonable to actually create some of the training materials ourselves.

So that those who do not want to have to build out the whole curriculum could actually access it.

So that's the new multi ceu series that will be building.

We also have to specifically teach people to notice when they might be engaging in behaviors that will interfere with relationship building.

And some of those are being more authoritarian versus authoritative versus permissive.

This is how we these are descriptors for how we communicate and make decisions authoritarian is typically when you are imposing your will and decision-making on others authoritative is when you are collaboratively, but appropriately making decisions that are consistent with Everyone's kind of values and greater good and permissive is when you are allowing things that likely shouldn't be allowed because it would be difficult or uncomfortable to deal with them.

So helping people to recognize those instances and when they are when they are squarely within the authoritative it is okay to know things that the family doesn't know.

You don't have to give away that knowledge and expertise in order to collaborate with families.

But you also don't want to ignore the knowledge and expertise and experiences that the family has because those are valuable as well.

Other behaviors that can interfere with relationship building or defensiveness that notion of basically protecting your ability to be right.

almost never enhances a relationship that said all of us as humans are super prone to it.

So it's one thing to kind of know it never helps us to be defensive.

And another thing to actually begin to recognize when you may be behaving defensively and the impact that that can have on other people.

Now one of the things that I I tend to be kind of Speedy brain fast talk or what have you and when an idea pops into my head, I'm excited about it.

I want to share it and that leads me to be a little bit prone to interrupting particularly.

When a lot of the interactions that I have are over a platform like zoom and there can be a little bit of a delay where you both start talking at the same time.

so I have to actively manage what I know is my No, No Malice intended, but it is my tendency to interrupt and I have to do things that help me manage that right.

So there are a kind of trained myself to do certain things with my hands like pressing them together so I can feel the pressure to inhibit me from starting talking and then when I start to talk, I release the pressure and I use my hands to talk.

So this is one of the ways that because I I talk with my hands I can limit when I talk in interrupt by limiting my hand motions now each person is going to have their own things.

But if you are somewhat prone to interrupting and you know, that's something that could actually interfere with the relationship.

It could inadvertently convey that I don't care about what you're saying.

I'm just waiting to have my turn then that's something you want to get good at managing.

And of course when we over focus on the negative, so you can do things to help you keep track of how many positive things have.

I focused on versus the negative or how long am I talking about this negative thing without interspersing what we like to see instead or What progress we're making in some other area?

All of those are things that can be actively taught and this is if this is one that I'm a little prone to as well, but jumping to Solutions too soon.

Whenever there is a problem that we're trying to solve.

Hopefully we've got good ideas.

One of those ideas is gonna pop to mind first.

It doesn't mean it's the best idea solution.

It may well be a viable one.

So really focusing on taking the time to oh, I've had that idea and I think it's a good one, but let's actively try to come up with a few more and less talk about why the benefits the pros and cons of each solution before we commit to one.

And then a last one to help try to sensitize people to is passing the buck.

That is a deferring responsibility.

Well, that is because whatever the school administrator the other person that kind of thing.

So those are the kinds of skills to teach and behaviors to help people learn to Monitor and let me say that it's always a good idea to view yourself as your first best people for your teaching efforts in this area.

But also when we can fully Embrace this we serve as a model to those around us and all of us have our or will have more Junior peers supervises trainees that are going to come along and this is going to be newer to them.

you know, we don't want to have to wait around for experience to kind of beat you up a little bit so that you learn by trial and error some of these things the more we can establish the value of these things and teach them at the outset the smoother those early professional experiences are so we do have good technology for teaching these kinds of skills.

in fact it amen and you know, it may seem like these are The subtle things could we really teach someone who's not good at this to do this, but the answer is yes, we can in fact teach empathetic behaviors and this literature comes not only from our psychology literature, but our medical skills literature.

So the answer is yes, we can teach these skills.

And in fact, we've had multiple randomized controlled Trials of these kinds of curricula.

And so this is from our medical literature what reason all did was they taught residence and fellows and they did 360 minute empathy training modules.

So we're talking about three hours of time and they did blind patient ratings.

So the patients actually rated how well did this person do on the care assessment?

e-a-r-e, which is an assessment of Empathetic care and the group that received the training just three hours 360 minute modules show greater changes in their patient care scores.

So it's not just experience people gain more experience over time.

But if we actively focus on teaching these skills We are perceived as more skillful.

And in fact, we're typically better able to manage our own emotions where we're in these situations that require empathy for others.

so in this study some of the kinds of materials that they used were also visuals and what they did was had people rate some of the nonverbal Behavior as either empathetic or unempathetic and that helped them to kind of teach people.

Here's the example of what you want to be doing.

Here's what you want to be avoiding so you can see on the left those impathetic.

Exemplars leaning forward neutral to positive facial expression whether male or female regardless of whether it's a white coat or a different color in contrast with that body posture and nonverbal stuff on the right that was consistently perceived as less empathetic or unimpathetic.

So by teaching people that these kinds of lean back across your arms, even though it may feel comfortable.

It's speaking.

It's saying something to the person that you're interacting with can lead people to do less of it.

And in fact to engage more like those photos and examples on the left.

so when we look at the behavior in Behavior Analysis, you have to do things in order to actually affect people in a compassionate way.

We can teach people to do things differently.

And often that means we have to try to approximate some of the circumstances that people will encounter.

It's one thing to practice leaning forward with a positive expression when you're talking about.

an educational program that's going pretty well and we're making good progress It's Different to consistently be able to do that when you're talking about something that isn't going that well because we have this natural tendency to withdraw a little bit to pull back.

So training has to occur in some semblance of the natural environment the practice the rehearsal it's got to be about things that might engender a little bit more emotion.

And in those natural contexts, you've got to have someone knowledgeable that's available to intervene with instruction when necessary So yes, role-playing can be great.

But you do have to role play the tough stuff and you have to have situations where it's as realistic as possible and the trainer can step in to help.

as you're practicing so the same things the same intervention and teaching procedures that we can use to teach anything else will work just as well for these kinds of empathy and active listening targets.

That means instructions.

You are encountering lots of these instructions right now.

Why does it matter?

How would you say it?

What is that open-ended question?

And why does it have a difference?

That's the instructions part?

But there's also a critical role for modeling for actually showing exactly what it would be like and what a skilled person would do.

Then of course, there's the rehearsal hearing about these things without the opportunity to practice typically doesn't result in someone feeling comfortable in the tough situation that could be ahead of them.

And then of course feedback that is someone else being able to convey when something's going well or not.

So well.

so that kind of practice with these skill sets is a critical part of teaching other people.

this ceu experience will really only help with the instructions and some of the modeling.

So one of the things to think about is if you find this is important are that there are at least some people who really need some additional support in this area.

How can you extend the training opportunity create those role plays and give them the opportunity to practice some of these things that are hard in a context that feel safe.

One of the other things that I always do when I am mentoring or supervising other people is I I ask them questions.

about their clients that will hopefully get them thinking about how important the relationship is.

So for example if I'm supervising someone who is a new or bcba or anyone I might explicitly ask them.

How are you and the family interacting?

How is that going describe that for me in doing so that's sometimes might produce the Insight that they have been thinking about that at all.

Right, they've not gotta prepared answer.

About what they've been reflecting about they have to generate it.

So this may be one of the first times that they're really thinking about.

How are we interacting?

Or how's the tone of your conversations with the family?

Can we put this item of family interactions on the agenda as a standing item when you do that you convey this matters today and it's gonna matter tomorrow and it always matters.

So let's keep focusing on this.

Maybe how is your rapport with this family or what are your goals for this therapeutic relationship with the family?

if you don't have goals for the therapeutic relationship with the family, you may be taking it for granted as just something that's gonna happen without actively.

Knowing what you want to achieve and then focusing on whether you're achieving it.

So anytime that you are interacting with other people that you are supporting mentoring training supervising asking these kinds of questions might be a great way to get them to think a little bit differently about how important some of these things might be.

This chapter in the book that I mentioned actually.

Includes a tool that I initially developed at Trumpet Behavioral Health when I was the executive director and then revised for the book.

So it's a therapeutic relationship self-evaluation.

We absolutely should be getting information from families about their satisfaction.

But I think there is a lot of value and periodically evaluating whether you are doing the things that were produced a good relationship.

If you got one anyway.

Maybe you just got lucky or maybe this family.

So needs you that they are giving you a lot of cushion to maybe have some things not go as well as we might hope and but if you actively self-evaluate some of the things that are useful in initially establishing the relationship and then in sustaining the relationship you may be more likely to engage in those behaviors.

So there are multiple items and there's a section That focuses specifically on the initial relationship establishment building that overall rapport with the client and the family's Guardians caregivers listening actively and carefully and there is a bit of an explanation of what we mean by each of these things validating emotions defining common goals flexibly allowing the client to discuss which things are important to them rather than forcing a highly structured agenda that you had going into the interaction considering cultural differences.

These kinds of things help to set the tone for a healthy relationship.

Establishing or re-establishing.

Hope the time that you put into that.

Reestablishing hope for a meaningful life and a future is a time.

That's well invested because it could make the difference between a family's motivation to do or not do tolerate or not tolerate.

Fully explaining that rationale and ensuring that families are completely ready for services at the recommended intensity in ABA services.

This is something that's particularly important for us because we often good teaching.

Only makes an impact when there is a sufficient amount of time that can be devoted to teaching and we all feel this and are given instructional day.

We're often desperately trying to find more opportunities for the teaching interactions along with everything else that happens throughout the day.

Well, the same thing is true in ABA services and the recommended intensity to actually make progress on teaching those new skills or addressing problem Behavior often is it odds with the availability of the family?

So if we know it's going to take this much to be able to achieve our goals that we want and yet the family isn't really ready to devote that much time.

It might not be time to start Services yet.

You may have to adjust your goals and what you do and how much you do of it in order to be realistic about what you're expecting to be the outcome of your services or to create more understanding and motivational what might be able to be achieved if we're able to eliminate a few other things that allow us to have full treatment intensity of services.

so and let's go ahead and take another five minute break, and I know that it is lunchtime.

Or getting to be lunch time for many of you.

So please do feel free to get your lunch during this next 10 minute break and I will see you at 12:10.

Jelly, I know you might want to give another ceu.

I do have one more.

Thank you for that prompt.

Sure the code for this one is 50880 and I will pop that in the chat as you get rolling.

That sounds great.

Okay.

Well, hopefully you had an opportunity to grab your lunch and we'll go ahead and get started again.

I want to talk about some specifics about skills.

These are some of the most common concerns that people might have one of the things that We might all see in ourselves or our colleagues or what have you is that some of the ways that we talk?

Our language can actually set us up.

To not have quite the right relationship with families.

So for example, when we talk about parent training one of the things to keep in mind is that most parents are they may or may not be excited about training on their parenting.

They may prefer a term like parent coaching or parent collaboration.

So if you call these interactions that you have parent collaboration, you're going to be more likely to do things in them that are actually collaborative rather than I'm going to train you and your job is to do with the way I tell you to do it.

One of the other things I often hear is almost.

Kind of a possessiveness by the provider.

This is one of my clients my families and of course we have to remind ourselves.

They are their own family and we are not part of it.

We are fortunate enough to have the opportunity to work with these families.

But if we think of it, it's like my student or my client that can almost set us up and if we use my goals can set us up to almost view the family as a bit of an adversary that somehow they have goals or you know, Engage in ways that get in our way.

Another thing or another phrase that I'm always a little bit worried about is when I hear a lot of talk about compliance and you some of your other speakers may have been talking about this as well.

But that notion of I need to get the child or student to do what I want and comply or even to get the parents to comply.

If we think about it as adhering or more fully embracing the treatment or Educational Opportunity.

We may be more likely to not only hurt feelings or convey that we're pretty sure where the boss of things but but to actually prompt ourselves to behave in ways that could be valuable towards building a collaborative partnership.

So actively thinking about our interactions with families as a collaborative partnership from the very beginning that we're all in this together and we've all got to play a part and starting from the beginning of our interactions viewing it as a partnership is critical.

So one of the things that I always encourage people to do is to kind of think about how they're thinking kind of meta thinking and and to recognize that if they are spending a lot of time in their interactions with families trying to get them to do what I want.

That should never be the goal.

There should be some different goals.

If you focus more on those different goals.

It may well be the case at the family's Behavior changes.

So instead of focusing on how do I get them to do what I want instead focus on things like rapport.

Building Rapport is your best way to be able to communicate effectively in a way that lets someone see the value of doing what you're recommending.

So in terms of Rapport, we know it when we see it.

We know this Kitty and puppy are in they like each other they're hanging out.

They're comfortable being close and in each other's space.

We know it when we see it and it is important and worthwhile to strive for that not only in the beginning of relationships but throughout and everything that we've been talking about that positive friendly demeanor asking those open-ended questions that convey your interest and show your interest offering information and rationale just reminding yourself don't assume they know understand or value offer that information smiling nodding even a positive tone of voice using the whole therapeutic tool facial expression tone of boys body language as well as your words.

Is a perfect way to establish Rapport not only with the student or client, but with their family and that means we have to think about the whole family as part of where we are making a difference.

The next set of skills that I think are critical or active and empathetic listening.

So, um, if you never been taught to engage in active listening, you may not recognize that You could be engaging in some faulty listening.

We all do some of the time where we hear things from our perspective.

It doesn't really match what the speaker intended us to to get from the experience.

But if you are in the role of the therapeutic agent then Being an effective listener really is your primary job and when we engage in faulty listening, it can damage relationships and it can inhibit future communication.

Someone knows you interrupt a lot.

They're looking for it in the future and they may just not prepare the things they want to say or be less willing to get started because you're going to jump in and interrupt and that can lead to barriers to progress.

child progress parent progress your own progress But good listening active listening strengthens relationships.

The goal is to hear and to hear in a way that builds the relationship.

And when you listen effectively it also Fosters listening on the part of the other person and it can lead to change on the part of both parties the speaker and the listener.

so if you want people to hear focus on your own listening and that may sound a little counterintuitive.

But in fact when you focus on your listening You are more likely to behave in ways that engender listening on the part of the other party.

So a skilled that listener takes information from the others while remaining non-judgmental and empathetic and acknowledges the speaker in a way that invites the communication to continue.

things like that's really interesting and it helps me understand.

What your afternoons and evenings are like, can you tell me a little more about that?

that's likely to get you information that you otherwise wouldn't have gotten and it also If the person that you're at interacting with is not always clear in their communication grab on to those ones where they are clear and specifically describe that and how it was helpful.

And that may be a way that you can shape them being more effective in communicating to you.

So in empathetic listening, we got to seek to understand before being understood comes right back around to Being right is not the goal being effective is the goal.

So understand first and that will lead to you likely being better understood and connect cognitively.

With active listening that means repeating back what the person says to make sure you understood you may have slightly misunderstood or you may have gotten a message that wasn't what they intended to deliver when you rephrase repeat that allows the person to know if maybe they haven't come across the way they have intended.

But you also have to connect emotionally identifying how the person feels making a statement about how they're feeling these are those core components of active and empathetic listening.

one of the things that you want to keep in mind is that You're not a blank slate when you are in the role of listening.

You are not like the the drum that is beat upon.

You have your own feelings your own perspective your own emotions while you're listening and you have to be aware of what those are and how it can influence your listening.

So if you've had a particularly challenging day with the student, it can influence how you listen to some of the things a parent or another professional might be saying about what the student is good at because your recent experiences may have been more negatively value with respect to what it was like to interact with the student.

So you can't erase your own experiences, but the more that you are aware of them and how they could be influencing your listening the better you are going to be at being able to take that step back and engage in perspective taking.

So one of the things to keep in mind is that you want to prepare for listening take some time before you listen to get yourself in a better place to listen and hear.

And focus on the speaker.

that is what do I think they are trying to convey now?

That means you have to kind of step out of your own role as just listening and instead actively kind of describe.

How are they sitting what's their facial expression?

You have to come out of autopilot a little bit.

And then have an awareness of your own feelings while listening.

This makes me feel uncomfortable because I know we're coming up on my needing to say something that's going to be hard to hear.

So I have to not avoid that.

But recognize that I'm feeling this and maybe it won't even hurt to acknowledge that I'm feeling a little tentative because I have to say something important.

And breathe and anytime we're in an interaction that is in any way emotionally charged particularly.

If it unexpectedly became emotionally charged.

We have to manage.

The only thing we can manage what we feel when we are stressed or distressed is our heartbeat.

But you can't control your heartbeat what you can control is your breathing.

Your rate of breathing and in doing so that actually is what influences your heartbeat your heart rate.

So take the time to breathe and don't hurry through these important interactions.

By monitor your feelings monitoring your feelings and how they might be affecting your listening.

You can try to limit them from interfering right?

I'm feeling frustrated.

And it might mean I'm not hearing so let me ask the person to repeat and apologize that I need to have it repeated and put myself in a better place to listen monitor your body language for those approach behaviors rather than those avoidance withdrawal behaviors.

And don't personalize the message, you know.

a parent can feel frustrated that progress is not More rapid without thinking you're a bad person when our own identity and value is so wrapped up in being effective and and making this change it can feel like they think I'm not any good.

They think I'm not doing a good job.

They think you know, maybe I think all of those things but very often the person who's experiencing the emotions is experiencing it in the context of their whole life.

Not just this thing that they're saying to you.

Allow for those pauses and monitor.

You can even while you're taking that deep breath.

That gives three to five seconds.

As a pause so that could be one of the things that you practice is.

after I ask an open-ended question Take that deep breath, which naturally inserts that two to four five second Pawns.

And that allows that opportunity for the person to kind of get a running start to giving their answer and opening up.

Stay focused on the feelings of the speaker which you have to do.

If you're going to actually make statements about how it seems I can I can feel your excitement about this and about how it's going.

Some of your interactions are going to be excited and positive.

All of those things are a part of active listening that most of us can do well when we recognize that we need to be doing it.

Well, some of us can do it almost all the time.

But for those of us that have not had a lot of training and practice this skill really is something that needs to be focused on and practiced and rehearsed.

Let's talk a little bit about some strategies for collaboration and good listening can foster collaboration, which is basically just the process of two or more people working together to complete a task or achieve a goal.

So when we set ourselves up to have the active goal of collaboration, we are more likely to be effective in completing the task or achieving the goal and we might even have entirely different goals.

so in terms of how to collaborate one of the most important things for Effective collaboration is really clarifying roles and expectations and actively staining out loud.

What you look forward to learning from the other person what role you think they have that you value and also describing your own and then offering the opportunity for the other person to just what do you think our roles here are going to be and what are your expectations?

You know we often are in a position where we're not the first provider or educational professional that the family has encountered.

And those previous encounters may or may not have been fantastic.

But they influence the expectations that they're going to have about us.

When we step in as number, two three, four five.

So this discussion at the beginning sometimes really?

Serbs to hit the reset button on the relationship and to establish the collaborative relationship is maybe different than some of those others that haven't gone as well as they could.

Also take the time to explain processes and procedures.

What you're going to be doing with respect to assessment how it informs your selection of goals or your treatments or what have you and invite input.

Tell me about two or three things that are important to you that aren't likely to show up in my assessment, but that you really want to make sure that I understand about your life and your family and and what you hope to get from this.

And then be open to those ideas very often.

We are not particularly open to ideas that we don't have the skills to meet.

So for example, well, I really am excited to tackle this and for my child to learn this and we view that as a little bit outside of our purview that can make us more resistant to those ideas, but it doesn't make it less valuable to the family.

So being open to those ideas and then discussing and compromising.

Could be the opportunity where you say, I'm not really an expert on that.

But let me talk with my colleagues and find some resources so that I'll be in a position to either help you or send you to someone who can.

compromise is truly a skill.

and the first thing about compromise is you have to know when it is appropriate to compromise.

and my my thought about it is almost all the time because it is not your child and not your family.

You have the privilege for some amount of time to try to be useful and Ultimately, you will be gone and they will still exist as a family unit.

and so thinking about where and when could I compromise if needed is something that you should always be ready for because When you're unwilling to compromise you often lose your opportunity to be effective.

One of the things particularly for individuals that are somewhat newer in their career.

Is that compromising can Feel like you're losing face or that you some you kind of are.

Looking like you don't know what you're doing.

And for many of us when we are new into our career.

We're kind of afraid we might not know what we're doing.

We have some of that hopefully we have a little bit of natural professional insecurity because we don't know everything but that can make compromising either feel like it shows that I don't know what I'm doing or yes, whatever you want.

I'm happy to do whatever you want which all so isn't compromised.

compromises that point between both points of view informed by both points of view that still accomplishes the goals that you have along with the goals are informed by the goals and barriers that the family has I also kind of, you know here new professionals saying I'd like to compromise but I don't want to look stupid if I miss an idea.

Why didn't I come up with that?

Or what if you got something wrong and so actually being able to practice for some of those professional apologies that you were likely to make at some point.

There will be some program or teaching procedure or lesson that doesn't go as well as you thought it would like that is a given that's our life as professionals.

And so being ready to comfortably give an apology about you know, I thought this was going to be a great lesson or program but he isn't progressing as quickly as well.

It's not resulting in him learning.

So I think we should modify it and we might be able to get there faster if we do this or this or this.

What do you think?

or you intended to have 13 things by this time, and you've only got 10.

Well that's going to happen.

There's a lot we do to coordinate the educational and and treatment services for a clients and their needs are Broad and pervasive.

So there's gonna be a point where you don't have something ready by the time that you thought you would so just have a professional apology at the ready to be able to say comfortably.

I'm I'm so sorry.

I don't have that ready for today, but I will get everything together and we can discuss it next week when I'm here or when we have our next parent meeting just be ready for those and assume that they're going to need to happen not every day.

Not every hour maybe not every week or even every month.

But the more you practice them the easier it is to make this kind of apology without feeling a dagger in your own heart.

and the point of compromise is to make be flexible and make changes but not the ones that would jeopardize Effectiveness.

So yes, it's always a good time to compromise but there are certain compromises that we know might be highly problematic and other ones that probably won't have an ill effect the more that you are willing to compromise.

The more meaningful it's going to be when you have to say.

I I want to partner with you and compromise but on this one, I'm really worried that X Y and Z might happen.

when that happens in the sea of collaboration and compromise, it really stands out as oh this isn't just because you want to be right.

This is something unique and important because all of the other time you've been willing to listen to my input and come up with other strategies.

so let's say you're working on all of these things building the relationship active listening compromising.

There comes a point where you have to think about how I know it's working.

How do I know that we really do have that effective relationship or that something's gone a little bit.

Awry.

Earlier, I showed you the first part of that self evaluation that is about establishing the relationship.

There is another portion that's about strengthening maintaining and repairing the relationship.

and it is absolutely reasonable to expect that.

Every relationship is going to have some Road bumps because we're people and everyone else this people.

And so when you have people in relationships things get a little messy and they get a little bumpy.

So that notion of actively reflecting on do I feel like communication is frequent open direct and comfortable.

Do I have evidence via email phone in person Communications that they feel comfortable they feel good.

Do I follow through on tasks and changes that I've discussed with the family again?

This is focusing on are you doing the behaviors that sustain the relationship?

And looking at these are something that you can do every day.

Evaluating satisfaction with the experiences something hopefully that you do periodically maybe every six months once a year, but these are things that you can reflect on every day.

Am I frequently asking for input and feedback and do our respond graciously and sincerely when that happens am I engaged for interactions with the family and do I work to kind of establish or reestablish hope or is that something I kind of let tail off after the first month?

It's like okay.

I established the hope all good now, let's get to work but that's actually something that you want to always pay attention to ensuring that the family understands the rationale for services and any changes that have occurred in services and assessing the families wellness and stressors and adjusting.

forwarding like sorry about that went wrong way.

So here are some kind of telltale signs they are good indicators that the relationship is working each party comfortably shares information.

There's not a lot of those kind of back Channel thoughts of oh, I don't want to tell them about that.

You're comfortable sharing information.

And that the interactions feel positive and appealing.

That you're seeing some compliments of the program the classroom the team the staff.

That collaboration is occurring and everyone is Comfortably a part of it.

that there's some openness that you know, there's not a lot of you ask a question and you kind of see the response of like well, that's not any of your business.

The flip side of that is there some signs that the relationship may have fractured somewhere along the path.

For example, if there's a change in the quality or frequency of communication or you never get to the point where there is good quality communication.

We're just feels comfortable to be interacting with someone that may be a sign that some more of those relationship building behaviors needed to occur early on.

Not showing up for meetings or arriving late for trainings meetings.

What have you can be assigned?

Maybe that the person is quite busy or forgetful but often can be assigned that they're avoiding some of those enter those interactions that focus on them rather than their child.

Canceling sessions meetings complaining negative interactions.

This isn't just an indicator that this person Is dissatisfied or demanding it is a sign that the relationship may be fractured and if it's occurring a lot it may be feel like it may be an indicator the person feels like they're not being heard and listened to when they say these things being closed off in meetings or avoiding on contact can be signs that the relationship is fractured.

And if you find yourself wanting to avoid eye contact, that's a good sign as well that something isn't right and healthy in that relationship and feeling like it's challenging to make decisions or dreading when there's one coming up.

Not collaborating or or feeling like you have a voice or that you're willing to give a voice to the other person lots of requests for documentation suggests that the relationship may be fractured and that there may be carry over from past relationships where something didn't occur the way it could have requesting meetings with a supervisor administrator or a boss.

They not only suggest that something might not be right with the specific program.

But also that's something might not be right with the relationship.

so if any of those things happen And you can expect that at some point in your career.

If not frequently that some of that will happen relationships can be fragile and some of them are going to require repair.

Nothing ever gets fixed by ignoring it.

So if you're going to repair a relationship, you actually have to address the change the behavior the fracture directly.

and and often that can come after open-ended questions about how things are going for example a question about You know, I'd love to get your input on how you feel.

Our communication is going.

Could be the opportunity we're regardless of what the other person says to either say.

I'm happy to hear that.

I've actually been a little bit worried about our communication and and wanting it to be more frequent or more direct or you know, I've been feeling that too and that's not what I want for us.

I know that this child is gonna benefit most when we can communicate frequently and effectively, so I want to talk about that.

Offering apologies when appropriate and recognizing that there may be some way that you've behaved that's helped to erect a barrier or cause some of that fracture.

No one person is ever responsible for the entire health of a relationship, but it never hurts to start off by accepting any of your own responsibility and apologizing.

And discussing Is there some other way that we could communicate that would work best?

Maybe it needs to be more face to face maybe more written.

Often relationships struggle when all communication subsides, but if there is a way to get at least one form of communication going you're really opening up those channels.

Maybe setting boundaries when appropriate whatever it might be that has started to feel like overreaching or too authoritative or whatever.

It might be on either party's part.

This is about clarifying those expectations and boundaries.

So it's not.

Comfortable to do this but that notion of always entertain the possibility that you your focus your behavior might be contributing to the situation.

So You know many of you work together in the bigger organization of at sea or you become each other's professional community.

And one of the things that we want to keep in mind is that Whether the we're talking about the culture of the relationship with the family and provider or the culture of our overall professional community.

There are these reflections of that culture.

So a positive collaborative work culture often leads the people in that culture to interact in more positive and collaborative ways with their clients and families.

So really thinking about How do we create cultures of compassion for each other and our clients kindness understanding about that?

Terrible?

No good, really rough day.

And integrating that humanity and humaneness into our training experiences compassion for our staff compassion for the paraprofessionals the rbts who work with us and also setting them up to understand how to have compassion then for our clients and students and Families.

You know, we this has to take into account what their skill levels are the client skill level whether someone's ill not feeling well that everyone makes mistakes and that we can always make a choice to move on and move forward.

Those are some of those critical points of a healthy culture.

So think a little bit about whether your culture is anchored in a classroom an Ava treatment team a school building an entire special education District.

What is the culture and how can you influence that culture?

Because when we don't have this culture of compassion for our clients and for ourselves, it has an impact on our stress and our burnout.

So I've said already multiple times you wouldn't be here if you didn't care and if you're professional reinforcers were not tied to the good that you do in the world in treating and educating our clients.

But those people who are passionate deeply committed or potentially more prone to burn out because our jobs are stressful.

and when what your experiencing at any given moment seems at odds with this Vision this identity that you had.

The regular opportunity to do good can kind of begin to see mundane tedious the everyday activities that make a difference can lose their positive impact on us.

So there are some clear signs of burnout and you cannot take care of other people if you are not taking care of yourself, so Think a little bit and perhaps even regularly assess your burnout.

One of a freely available tool is the maslach burnout inventory.

This is something that your teams could download and periodically complete are you feeling those physical and emotional exhaustion?

Signs or symptoms or cynicism and Detachment.

If you're finding yourself kind of feeling like parents or the enemy or the barrier that might suggest you become somewhat detached from their experience.

Are you just feeling ineffective and hopeless about what you do?

When in fact you likely are doing good every day.

If you ever do experiences it can feel like you're very alone.

But in fact you're not.

Particularly in in healthcare in Behavior Analysis at early career points burn out is real and it is a danger.

It is a risk.

in these studies of behavior analysts Two of every three respondents were experiencing moderate to high burnout and one in every three were experiencing little to no job satisfaction in a job that is specifically about doing good in the world every day.

It is real.

Chapter 12 in that book on supervision and mentoring actually gives a variety of strategies for keeping us in the game a long time.

Certainly in the United States.

We experience a real teacher shortage.

We need more teachers perhaps you have some of that in Canada as well in ABA Services.

We are desperately looking to expand our ranks.

We mean so many more people to meet the demand.

That means each person that actually gets in the game.

We want them around for a long time for a long positive enjoyable sustained career.

And one of the recommendations is monitoring and addressing burnout and engaging and self-care.

That's a big part of how you keep yourself healthy and well.

So take care of yourself.

Remember that there is you cannot help others.

If your cup feels empty those small things reflecting on the positive things that you're doing every day.

Building strong relationships with your the families of your students or the the clients that you serve that not only removes stressors.

It puts you in closer contact with the real and meaningful long-term reinforcers of what you do every day.

So remind yourself that you absolutely will make mistakes as a professional.

That's why it's okay to apologize.

That's why it's okay to compromise.

All of these activities are not only about building the relationship that you have with your clients and their families, but it's also about strengthening.

Some of that compassion for yourself to not hold yourself to a standard of you shouldn't make mistakes or you shouldn't need to compromise because you should be right at the outset when we extend that compassion to ourselves our last topic on the agenda.

We set ourselves up to more robustly love our careers and to be in the game doing the good we do in the world for a longer time.

So this is a list of resources and yes, I believe I have already sent a handout of the slides and those can be distributed to you.

So that's what I have today and I love to hear your questions or comments or what have you in a few minutes.

We have left and Shelley you may have another ceu code for folks.

I don't know.

No, I think the two would be good and I can see folks logged in so it can count that as their log in and log out we check on them when they start check on them when they can fantastic and Shelley.

I see that you have put in a link to the mass like burnout inventory.

Thank you so much.

And oh and also to the podcast and the book fantastic.

I appreciate you doing that.

Well any questions that that have come up for anyone now, it's a great time to ask.

And maybe just as if anyone's typing as they're typing I can just turn it over to Ryan Adams for a minute.

Sure, so, thank you so much Dr. LeBlanc for your time and presentation, you know often our focused in our Focus to support students.

We may not recognize our own behaviors that maybe interfering and developing those relationships with families and caregivers and you know as you Research indicates, you know, this really can affects some of that student progress, which we certainly don't want as you so clearly stated being right should never be the goal, but being effective should be and thank you for sharing with us tools and skills that will enhance our practice and build our collaborative Partnerships in order for us to be effective for students and for families.

So we really value your time that you spent with us today, and we very much appreciate and respect your work and thank you for your time.

Thank you, and I always tell Shelley my some of my best and favorite interactions, or when I get to spend time with your team and apps see I appreciate you having me back and I'll always be a eager participant and admirer of of your team and your broader service organization.

So keep up the good work in Canada.

I'm rooting for you.

Well, we value our partnership with you and thank you very much and just a quick reminder to everybody that are next session starts at 1:30 Atlantic time.

So just to remind her about that.

So I'll just check back in with Shelley to see if there's any more questions.

I'm not seeing any more questions.

I'm seeing lots of great comments and lots of thank yous and lots of insights and Reflections and aha moments.

So it's been a great three hours and thank you Dr. LeBlanc for hanging in with us for three full hours Dr. Raja.

Raman said yesterday.

It's it's kind of like Lord of the Rings.

So through three full hours of presentation.

So thank you for keeping us engaged and for spending this time with us.

So we'll see everyone on the next Link in about a half hour.

Thank you.

Have a wonderful day.

Thanks.

Bye.