You are only as good as your direct-care staff.

By Clelia Sigaud, M.S.

bSci21 Contributing Writer

Over the next few months, I will be sharing some thoughts on leadership and direct clinical roles within the field of behavior analysis, from the point of view of a professional fairly new to the field and to supervisory roles. As a former paraprofessional myself, it was very natural for me to gravitate first to the topic of direct care staff.

I was in college, exploring a career as a general education teacher at the elementary level, when I first learned about the staffing structure our society has developed for meeting the support needs of individuals with disabilities. Up until that point, if you had asked me what a child psychologist’s work day looked like, I would have described a scenario in which he or she put years of experience and formal training to good use by serving as a child’s direct service delivery staff. Indeed, I entirely refused to believe it when I first heard that our society’s most complex learners are generally supported throughout their lives by staff who are literally the least trained and lowest paid of any role category within our field.

Needless to say, much time and many experiences have passed since then, and my assumption is now safely regarded as an idyllic flight of fantasy which is very far from reflective of the realities of direct care. One thing remains abundantly clear, however — there’s nothing simple about what we do, and to place the bulk of the responsibility for clinical intervention on the shoulders of individuals with, in many cases, no formal education in behavior analysis beyond on-the-job training is to expect far more from our staff than we expect of ourselves. It is one thing to write an exquisite FBA report, and quite another to weather the storm of extinction that will result from the application of its recommendations.

We, the BCBA’s, lead teachers, supervisors, administrators, mental health clinicians, and whatever other titles our jobs might entail, must be ready and willing – and overjoyed – to fully participate in direct service delivery. “Sitting with a client” for a few moments to cover for a direct care staff member is not even close to sufficient. We don’t “support” our staff in their roles. We work alongside them. Their responsibility is our responsibility, and their skill is our skill. We as leaders are only as good as our direct care staff, and they are only as good as the training and resources that we provide for them.

Our staff members need respect and recognition. They need to be regarded as full stakeholders in client success, and equal members of the treatment team, as, indeed, they more than amply demonstrate every day, if only by virtue of their job description.

Our staff members need our investment as professionals. They need to be trained thoroughly prior to beginning work, and have access to frequent and ongoing feedback throughout their direct care careers. They need us to believe in their ability to develop phenomenal clinical judgement.

Our staff members need our acknowledgment that the work they do is very challenging. They need us to to do it with them, certainly metaphorically as equal team members, but also literally as DTT-implementers, PECS-laminators, and bathroom-cleaner-uppers. As long as we are in this field, we cannot ever “walk away” from the realities of direct care. Even if our roles eventually preclude us from providing it ourselves, our clients’ outcomes – and therefore the quality of our work as a whole –  are intrinsically tied to the quality of interventions they directly receive. Any resources we divert from our direct care staff members are resources that we refuse to contribute towards client success.   

Let us know your thoughts on the role of direct-care staff in the comments below, and be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!

Clelia Sigaud, M.S. is a teacher to children with developmental disabilities in urban Maine (to the extent that “urban” and “Maine” can be used in the same sentence). She has several years of experience working with special needs individuals, from preschool through age 20, in a variety of settings. Outside of work, she is earning her doctorate in School Psychology from the University of Southern Maine. Her interests include functional communication training, interventions for sexualized aggression/sexually problematic behavior, treatment of self injury, paraprofessional training, and ethical practice within the field of ABA. In her spare time, she enjoys authoring her own social stories.  You can contact her at [email protected].