Association for Behavior Analysis International

Applied behavior analysis (ABA) autism service organizations operate within a macrosystem of variables external to the organization that influence quality. For example, organizations can promote quality assurance through accreditation. Alternatively, organizations can look within and arrange contingencies controlling cultural practices that comprise high-quality services. This symposium offers insights from quality leaders on how two ABA autism service organizations assessed cultural practices that impact quality assurance from within, identified opportunities to improve quality, and took steps to enhance quality of care through large-scale change. Leaders from The Place for Children with Autism describe a phased approach to a large-scale implementation of the ABA service delivery quality (ASDQ) framework to advance quality assurance in their organization and discuss some of the limitations and barriers they overcame. The National Director of Clinical Quality at Acorn Health of Michigan describes their phased implementation of a major quality initiative with a Universal Protocol targeting improvements in rapport building across over 1,000 Board Certified Behavior Analysts (BCBA®) and Registered Behavior Technicians (RBT®). Attendees will learn about the initiatives, methods used to enact those initiatives, outcomes as indicated by data, lessons learned, and some tips on how to improve on the methods presented.

BCBAs working in ABA autism service delivery, especially BCBAs in leadership roles

In Silbaugh & El Fattal’s 2021 article ‘Exploring Quality in the ABA Service Delivery Industry’, the authors explore that an objective, agreed upon, and operationally defined definition of quality (or quality services) remains difficult to locate in behavior analytic literature. If a robust definition of quality service delivery does not exist or is not widely disseminated, the measure of quality across the field remains inconsistent and subjective. Applied behavior analytic service provider’s failure to objectively define, measure, and monitor the quality-of-service delivery at organizations continues to place consumers, caregivers, front line service providers, and our field in harm’s way. This presentation discusses one application of this framework to an organization of roughly 50 behavior analysts and 300 clients. Preliminary data suggest that an ASDQ framework for defining, measuring, monitoring, and influencing quality as proposed by Silbaugh & El Fattal is one potential solution for service providers in the ABA service delivery industry. Real-world limitations and potential barriers to implementation are discussed.

Research suggests building strong therapeutic relationships between care providers and the individuals they treat can lead to reduction in problem behavior and increased cooperation with demands. This relationship quality – often referred to as rapport – has an impact on every interaction and can influence client outcomes. At Acorn Health, we embarked on a mission to train every staff member who works directly with clients – over 1,000 BCBAs and R/BTs – on how to implement Universal Protocol, a standardized rapport building approach. Each business unit identified a UniPro Champ, someone designated to provide in-person training who was paired with a member of Acorn’s Clinical Leadership Team. Clinical Leaders provided training support, conducted integrity observations to ensure fidelity, and collected interobserver agreement to monitor data accuracy. The training consisted of a two-hour interactive presentation on Universal Protocol followed by in-person training and integrity observations. This approach was rolled out among Acorn’s 70+ business units in six, two-week training sprints. The data presented represents all Phase One participants, the number of training sessions conducted for each, the percentage of integrity observations conducted by the Clinical Lead, and the average integrity observation score across all training sessions.