Todd A. Ward, PhD, BCBA-D
If you are providing in-home therapy as a Board Certified Behavior Analyst (BCBA), your ability to form a positive relationship with the family you are working with is critical and is one of the most important components of your job when starting a new case. Failure to do so in a timely fashion can make or break the success of your therapy.
Most BCBAs are excited to take on even the most challenging cases, such as those involving severe aggression, property destruction, or self-injury. For them, the client themselves doesn’t really make or break a case – not establishing a positive relationship with the family does. If the parents are still learning to trust the BCBA or an approach based on the principles of ABA you may find that they aren’t on board with the treatment plan that has been developed. If this happens, you won’t get far.
A crucial skillset here relates to something known as “pairing.” If you are good at pairing, you are good at getting people to like you quickly. People will want to be around you and see your presence as reinforcing. When you are pairing you are literally “pairing” yourself with other reinforcers. These reinforcers can come in the form of your words, actions, body language, preferred items, and preferred activities.
The majority of BCBAs understand the importance of pairing and pairing with the child is usually the first step of the therapeutic process. However, what is just as important is learning to pair with the family.
Pairing starts before the visit. You have limited time at the start of the case to conduct an assessment and write a treatment plan. Before your first visit to the house, call ahead and talk to the parents for 30 minutes to an hour. During the call, show an interest in and empathize with their journey, their needs, and what they are looking for in services.
Calling ahead can also save time during your first home visit. Asking the parents about what their child likes, and asking questions about their child’s language, social, and daily living skills can help you get a ball park idea of where their child might fall on a common assessment such as the VB-MAPP or the ABLLS.
First impressions matter. When the parents pick up the phone for the first time, sound happy and interested, even if you are having a rough day. When the parents open the door at the first home visit, look them in the eye, shake their hand, and smile. From the parent’s perspective, they are considering whether or not to trust you and other staff in their home for several hours a week with their child. If you start off on the wrong foot, you may not be able to recover and the parents might request a new BCBA or go to another agency altogether.
Be respectful of household rules. Every household is made up of different cultures, backgrounds, and lifestyles. Little things that show you are mindful of these differences can go a long way. For example, asking about their shoe rules before entering the house is a simple thing that shows you respect the family and their house.
Be comfortable around kids. If you aren’t comfortable around their child, the parents aren’t going to want you in their home. Generally, you want to be relaxed and cheerful around kids (barring particular sensory issues). Take advantage of your initial phone call to ensure you bring things with you that the child likes (e.g., bubbles, play doh, etc…) and show and interest in the child’s own toys and preferred activities.
The pairing process never stops. Some may think of pairing as something that only happens during the first few days or weeks of a case. However, pairing should never really stop. And if you think about it, it makes a lot of sense – if you are working with the most important thing in a parent’s life you will always need to be mindful of the interests of the parents and client and continue to be the positive person who picked up the phone and called them at the start of therapy.
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Todd A. Ward, PhD, BCBA-D is the President and Founder of bSci21Media, LLC, which owns the top behavior analytic media outlet in the world, bSci21.org. bSci21Media aims to disseminate behavior analysis to the world and to support ABA companies around the globe through the Behavioral Science in the 21st Century blog and its subsidiaries, bSciEntrepreneurial, bSciWebDesign, bSciWriting, and the ABA Outside the Box CEU series. Dr. Ward received his PhD in behavior analysis from the University of Nevada, Reno under Dr. Ramona Houmanfar. He has served as a Guest Associate Editor of the Journal of Organizational Behavior Management, and as an Editorial Board member of Behavior and Social Issues. Dr. Ward has also provided ABA services to children and adults with various developmental disabilities in day centers, in-home, residential, and school settings, and previously served as Faculty Director of Behavior Analysis Online at the University of North Texas. Dr. Ward is passionate about disseminating behavior analysis to the world and growing the field through entrepreneurship. Todd can be reached at firstname.lastname@example.org
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