Field Talk is a monthly blog post sharing the voices of early childhood providers who serve or have served military families of young children with disabilities (birth to 5 years old). We hope you find it to be educational, personable, and encouraging.
This month we talked with Monique Baker, MA, BCBA. Ms. Baker is a Behavior Analyst and co-owner of Effective Interventions. This interview has been edited for length and clarity.
What is a BCBA?
A BCBA is a Board Certified Behavior Analyst and is a credential offered by an international board (BACB). In order to receive this credential, a person must earn a Master’s degree in an approved program, acquire 1500 supervised fieldwork hours, and pass an exam. While many people who become a BCBA may work in the field with children or adults with autism or similar populations, a behavior analyst can also work in many other areas or fields as ABA is the applied science of behavior and is applicable across many areas.
Describe your current role.
I am the co-owner of the company Effective Interventions, which serves children with Autism and related disorders using Applied Behavior Analysis. Sara Carbone (the other co-owner) and I serve as program directors running the ins and outs of the business, as well as continuing to provide one- on -one therapy for children, supervising Registered Behavior Technicians (RBTs), and conducting parent training and collaborating with teachers and other providers. We have 5 BCBAs and 5 RBTs that we supervise. We have run this company since December 2014.
What’s your favorite part of your current job?
My favorite parts of my job are working with parents and helping them develop strategies and interventions, and being able to see changes in their everyday routines that affect not just their children’s lives, but their whole families lives and interactions. I also love working with kids one on one and could never give that up. There’s nothing better than seeing a child use a new skill that you have been working on in a meaningful and functional way, or watching a child communicate with his/her parents or peers for the first time in a way they haven’t been able to do before.
Tell us about experiences you have had working with military families.
We are so fortunate in our area to work with a large number of military families. Over 75% of our clients are active or retired military and it is such an honor to be able to serve the children of these families who give so much to our country. Many times these children have frequent transitions and it is so important to be able to help families provide consistent high-quality care for their children. I have worked with some families for 6-7 years, which I believe creates consistency of care when you know a child and family that well and can help them deal with changes due to deployments and other changes to routines. I feel that focusing on parent training and support is especially meaningful and important to families for oftentimes one parent may be the sole caretaker for extended periods of time and need additional support during those times. It has been my experience that military families are incredible advocates for their children and the services that they need to receive. It’s been a great learning experience working with them and collaborating with other providers along the way.
How did you come to work with military families?
I have worked in the field of ABA, and with children with developmental disorders or delays, for 15 years. I was lucky enough, when I moved to this area 10 years ago, to begin to work with primarily military families due to my location around the Fort Bragg area. The fact that TRICARE began covering ABA therapy in NC before other insurance companies in our state, impacted who became my clients.
Describe a rewarding experience working with military families.
I have had so many rewarding experiences working with military families. Some of the most rewarding ones came from working with families over a long period of time and seeing their children develop skills over time. I have worked with children from a very young age, when there was very little to no verbal communication, and have been able to get to a point where we are working on higher level skills such as developing self-monitoring and higher level social and conversational skills. It’s also been very rewarding to have families come to you to discuss a child’s problem behavior that they have not been able to decrease and to figure out the function of the behavior and teach the child an appropriate replacement skill and see that problem behavior reduced until it is no longer present.
Describe a challenging experience working with military families.
I think the most challenging part of working with military families can be trying to help families while dealing with the wait times and challenges of enrolling in the Exceptional Family Member Program (EFMP). Another challenge surrounds understanding and being able to navigate the authorization process to begin services quickly when their child and family desperately need services to begin quickly. Communication with TRICARE has been challenging in the past, but they are definitely putting measures into place to speed up and simplify this process, and we have seen a positive evolution of that over the last few years.
From your experience, how are military families similar and different from other types of families? How do you change your practice between families?
We approach every client and situation as an individual and we design treatments and programs based on the unique skills and family dynamics surrounding each client. That being said we recognize that military families definitely face more challenges with changes to routines, and they may need more support when one family member is deployed or even when that family member returns. For example, additional parent trainings are needed to make sure everyone understands and implements a treatment plan in a similar manner. As a result of how much we see this type of situation in the military population, we have created a structure for all of our clients to promote a high amount of parent training and involvement. In addition, to frequent parent trainings we provide monthly updates that are sent to all members of a child’s team including the parents so that everyone is consistently updated on progress and treatment goals and on the same page with interventions and procedures.
As providers, how can we support military parents who are deployed or away frequently due to trainings/school?
As I mentioned above, frequent communication is crucial. We make sure that, if possible, emails are sent to the deployed parent; these contain updated progress reports and treatment plans. We recognize that when a military parent comes home, additional time and support may be needed for the parent who has been gone for an extended amount of time.
Describe a specific stressor that military families with whom you have worked have shared or experienced.
I think a feeling of isolation or being overwhelmed is very common with parents with whom we work, especially when their spouse is deployed. Oftentimes families move to a new area and then a spouse is deployed leaving the remaining parent to care for their children alone in a new area. Also, there are the additional stressors that come with having a child or children with autism such as taking care of those children on your own with limited to no babysitting or respite, limited adult interactions, and the need to schedule multiple therapies and doctor’s appointments to name a few. It has been my experience that military parents are an exceptionally resilient group of parents but the stressors and demands that are placed on them daily are intense and can be very overwhelming.
What “insider” tips or advice do you have for service providers working with military families who have young children with disabilities?
Get to know someone in TRICARE’s authorizations department by name and get his/her contact information! But in all seriousness, I think staying on top of authorizations and the ever-changing authorization requirements and having good communication with your families about what is needed and when it is needed, is key to providing consistent care without interruptions. It is also so important to build relationships with your families and really listen to them and ask what they feel is important for their family and child, and then make sure to include those as goals on the treatment plan. I feel like this is often left out and yet it is so important.
If you could change or improve one thing for military families with young children with disabilities, what would it be?
I think for those of us providing ABA services, I would want increased communication from TRICARE about policy changes or modifications to their programs or procedures, which greatly impacts military families. TRICARE frequently proposes or enacts policy changes without a lot of communication to families and providers; this can be a source of a major stress for families and cause issues with service delivery. I do believe that TRICARE staff has recognized the need for increased communication and they are working on it, but it is still a work in progress.
What types of resources have you sought out to feel more confident and competent at meeting the specific needs of military families? (e.g., trainings, blog posts, organizations, etc.)
TRICARE has recently begun having roundtable discussions with providers in which we can hear proposed policy changes before they are enacted, and then provide feedback or get clarification on policies and procedures. I would highly recommend that all ABA providers attend these. For my colleagues and I, attending these has increased our ability to effectively communicate changes and stay on top of current procedures and upcoming changes, so that families are able to get consistent care without delays in authorizations or other procedures. OneOp (MFLN) has been a great resource that we have more recently discovered; it is a great resource for families we work with, as well as, providers. The Autism Care Demonstration page is a great web page where changes to the Autism Care Demonstration program (which is how children access ABA services through Tricare) are noted.