For this high-leverage practice, we are talking about using student assessment data, analyzing instructional practices, and making necessary adjustments that improve student outcomes. With me this week I have got Alex, one of our BCBAs, who works in kind of a hybrid clinic school environment. And I'm really excited to see where this conversation goes because before we started recording, we were having a great conversation about how this shows up in our different practices.

So, Alex, for you, in your setting and kind of what you see, how does this high-leverage practice show up?

So it may appear a little differently than how we do things here at TLC. From a clinic base, usually we start off with an initial assessment, meaning the child will come to the clinic. We conduct our initial assessment using our assessment tools such as the VB-MAPP, AFLES, whatever the case may be. And then from there we will use that baseline. We'll figure out what his skills are, what his strengths are, and then if we need to do school based services, then we'll explain to the caregiver that we need to conduct a school observation.

And that school observation will be a very detailed report, day by day. I mean hour by hour, minute by minute, exactly what was going on his school day. We even split it up by subject periods. And usually we'll at the end have like a tally of  all the target behaviors we observed along with our behavioral definition. And then from there we'll present that to the mother or caregiver in question, and then they will review the report, and then we will call our funder and state our case. And if our funder approves us, we go into the school, we'll target all the skill deficits that we noticed in the initial assessment, and we'll also be conducting teacher trainings. So teacher trainings are a part of most private funders, meaning we need to do this. Just like how we meet with a caregiver, we have to meet with the teacher as well to make sure that whatever we are doing in the classroom is being transplanted with them. And they're carrying out the same interventions.

Usually with funders, they don't want us in the school forever, as much as we want to be at the school forever to be able to support our clients, they don't want us there forever. So when we're there, it's get the job done and be out before anything else. That's not always the case, unfortunately. We cannot get in there and do our job within a six month period. We do have to extend our time there, unfortunately, depending on the child and their deficits.

But the goal is always trying to fade out. We never want to be there, overstay our welcome. We want to just always leave a good impression. We always want to be understanding to the teacher. We always want to be supportive. We also want to make sure that the child is feeling supported and everything that they are granted as part of their IEP is being accommodated to them. And, yeah, that's essentially what it looks like on our end when it comes to the clinic based style.

Well, and to be clear, I mean, when you're saying funder, you're talking about insurance companies, and that's something that in the school setting, some people might hear talk or if they're like service providers, they might know about like billing Medicaid and that's kind of like a public reimbursement system, if you will, in the public schools. But you're talking about all kinds of, I mean, think like anyone who has benefits and they have their own insurance, you are talking about going to those companies to basically request approval to provide support to the student, their family, and of course, then if it's in a school setting, to also those school professionals, but you're not reporting to the school, you're reporting to the insurance company, and you can only do what that company permits you to do.

And that's where I think you see this high leverage practice different from what I see. I see it as a classroom teacher and going, well, like, I can do behavioral observation in my classroom and I can do some informal curriculum based measures and like those kinds of things. And I can then inform my practice based off of that. So I love that when you and I first started talking about this, you went straight in, like, this is the kind of data I need. If I don't have that data, I can't get approval to provide services. So it doesn't even matter what adjustments I might recommend, because it ain't happening if I don't have that data, where, for me, I'm going to let the data just affirms that I'm doing what I need to be doing and uncovers some things that maybe I didn't notice because I wasn't looking for it in that database way.

I love just the dichotomy there, where we're really talking about the exact same outcomes. Like, how can we make those adjustments that can truly improve those student outcomes? But, man, how we approach it and how we see it is completely different, primarily because of who we're reporting to.

Yeah. And that also makes, when we do school services, a bit tricky because it's kind of like we're tap dancing on landmines. We're trying to navigate, trying to teach these skills without overstepping on what the funders restrictions are, whereas with TLC, you guys could do what you need to do as long as it's contracted by the district. I can't teach a lot of certain skills because it will cross into academic, which is crazy because we're in an academic setting, but we cannot target those, anything that would look like an academic. So it does make our job a bit trickier.

But there are ways to work around that. We do a lot when it comes to those academics, we always work on it with the teacher, so that way, the teacher is being equipped and being able to work with our clients. So that way, yeah, we're not teaching the academic. We're not teaching, we're not overstepping what the funder wants, but we're still being able to teach that skill in a different way. And through that, that's how we've been able to target those trickier skills.

For sure. And, I mean, a couple episodes ago, Chris and I were talking about how to even just beyond direct observation, all the different kinds of data that we have about a student and where they're coming from and what their needs might be and what their potentials are and kind of like how we capture that. I got to have that conversation with Chris a couple of weeks ago. So I'm really curious to hear from you, if we say okay, we've got all this data. We've either done it through record reviews or other pre-existing data that we've got or things that I caught in the moment as I'm in the classroom, I'm watching. I'm seeing. Then what? The goal is that we are then making those adjustments. So can you walk me through what would that look like to basically make adjustments based on data? Like, what are you looking for? How are you making those decisions?

Yeah, so when we're there, everything that we do is data driven. So everything down to the behavior plan, to the skills that we're targeting, it's all data driven. When we get that initial assessment, we get that baseline. We know, okay, this is what our client can do. This is where they're at. When we get into the school, we do our observation. Then we also, at the end of our observation, we will speak to the teacher and be like, hey, what do you see? What is your perspective?

What are the deficits? What are… Is what I'm observing and what I got in that initial assessment matching up to what you're seeing in the classroom, because at the end of the day, two different settings. You bring a kid to a clinic, conduct an initial assessment. It could be party time because there's a lot of fun toys everywhere, it's a very different environment. We might see things that maybe the teacher doesn't see and vice versa. They're working in the educational setting where it might be aversive to the client. I don't know. You know, it depends on the client. Some kids love being at school, some don't. So they may see something completely different. They're like, oh, no, but this is where they're struggling, and we may not see that. So that's really how we kind of come to the idea of what our goals are going to be, because we look at the initial assessment, we look at the observation, and we hear that caregiver report, and we also get that teacher report, and we kind of put that all together, and then that's how we figure out, okay, this is what we're going for. This is what our target's going to be. This is how we're going to start it off.

And we just [hit] the ground running from there. We just keep going. And so our whole idea when I'm there and for all of my goals, I always have embedded, like, “therapist is at a certain distance”. The idea, so we could fade out of school eventually, is that the therapist, as he's the child's meeting mastery of the goal, the therapist is fading back more and more and more and more to the point that they might be 6ft away and the client is still doing what they got to do.

And that is our ultimate goal. It's just as they're showing that proficiency in the skill, we're being able to fade back. And then that's how I know, okay, we're on the right trajectory because if we're being able to fade back and our presence might be causing some sort of reactivity. Maybe they're behaving a little better because we're there. But the idea is also that through the teacher trainings, they're able to carry out anything that has to be more direct. And then that's where our therapists really shine because they can also prompt the teacher, hey, you know, this is happening, and then they could jump in and they implemented it.

Again, main goal we're there is like, teach the skills that need to be teached and fade out.

Yeah. So I'm curious from how you've seen this show up, I mean this whole season we're talking about all these different high leverage practices and we're talking about what it is, but we're also talking about what it isn't. And so to me, an example that I have seen when I get pulled into either different classrooms that are frustrated with certain students or just students that are just really struggling at the moment and we can't figure out why, one of the things that I have seen teams attempt to do, where they're kind of like framing it as though it is that database decision making, as if they're trying to use the student data to kind of make their case on what they think should happen with the student, that I don't think would necessarily count as this high leverage practice is when they're looking for data to kind of prove their case, as opposed to the way you're talking about it is like we collect all this information and then based on that information, then we go try some things and we see is that making that progress? We're tracking those outcomes over time.

An example that I've seen show up is, well, this is the outcome that I want to have, so I'm going to go find the data that then kind of proves my point. And quite honestly, I've sadly sort of worked with some teams that then have omitted some data that would actually counter their current argument. But so, yes, it's using assessment data, but it's not really using assessment data in the full, holistic sense of, are we truly taking into consideration all of the things?

And that could truly be, like, you're talking about those deficit areas and those things that they need to work on and improve on. Like, typically, if those things don't exist, people like you and I aren't called in. But it also is looking at, like, what are those strengths? What have they got in their wheelhouse? I also look at compensatory skills, because a lot of my students are kind of higher functioning, and they've got workarounds and ways that they've learned to save face or hide in plain sight. And so, like, those are skills! It may not be showing up the way we want it to, and it might be hiding the stuff that we actually want them to work on.

But that's a great thing. So how can we take that and then leverage that on behalf of getting toward those outcomes? So, I don't know, that's an example that I see from my practice. Is there anything that you've seen that you're kind of, like, I mean, you're saying that's a data based decision, but I don't know that you're actually accurately leveraging that student data or quite honestly, because you're reporting to funders, then it may not be as big of a thing because, you know, your funders, like, that won't fly with them.

Yeah, that's a tricky one. Tricky in the sense, because with my experience, it has seemed to me that our data more accurately reflects what goes on in a child's day versus data that the school collects. And not necessarily because the school is not doing their job or doing what they have to do, but they all collect data for certain periods of time versus us, we're collecting the whole entire five and a half hours that were there.

We're collecting very intensive data on every single thing. So when we compare our data, there's discrepancies. It's funny, I'll never forget it. One of my clients, the mother of my client, I should say. We were talking about it during a parent training, and the teacher would always send out reports, like a behavioral chart, happy face, sad face, all that type of stuff.

And then a little note that, like, oh, this is what the day was, and it'll be like this little excerpt about a really bad moment in the class. And when we talk about it, I would look at her, I'm like, oh, yeah, but I was there that day. That happened, like, for, like, ten minutes. That was not the day. But then that's where we see that discrepancy. Now the mom thinks that, oh, my child had the worst day ever. And I'm like, no, if you actually look at the document that we have, our note, you just see that that was, like, for ten minutes that happened. And we're just working through it using our interventions, and then we're able to de-escalate, get to a state of calm and continue on with the day.

But so that's where I see a lot of that discrepancy because the school collects data on their end, but it may not be as intensive as ours. And it will give really, you know, depending on when they collect that data, it could really make the day look worse than it actually was. And that's when it comes to everything on our end, when we have to provide that information to the funders and anything like that, at the end of the day, we try to use what they have and we compare it to ours, and we're just like, hey, this is everything.

We give it to the funder, and this is what happened. This is the day. This is our data. This is their data. And we try to state our case with that. And more often than not, they look at the data depending on the child and depending on what target behaviors are being observed and the intensity of them, that's what they'll make their determination on.

Yeah, it's so tricky. Like, on one hand, I'm thankful that staff are collecting data, but then are we collecting it in a way that is truly representative of what's going on but also is totally doable for the staff? And that's where we've had lots of conversations in TLC on how can we set up efficient data collection systems that provide meaningful data that is an accurate snapshot of the student and the situation, but is not just this administrative, clerical burden to be able to collect it accurately and then to be able to utilize it to truly make real decisions coming out of it as opposed to being like, well, I already know what I'm going to do with the kid. I just got to fill out these dumb forms because that's the data I have to have for it or whatever. Because if the system of data collection is so cumbersome that I, as an educator, cannot juggle that on top of my instructional load with the 30 bodies in my room, it's not happening.

The validity of that data is absolutely questionable. So that's where from our angle, it's like, okay, then how can we set things up that it's not? You can truly take accurate, good data, but you're set up in a way that that's not going to impact your ability to also be a good instructor, to be a good support to your students, and to be responsive to the needs that show up when they show up. So it's just different, you know? Different positions, different roles, and trying to make it all meet together to figure out how we can do what we need to do for kids.

Out of curiosity, have you found a way to present a data collection system that is easy to do for the teacher? Because I would love to know because that's always been something that I wish, at least in all the school cases that I've had where it also depends on the teacher, too and how willing they are to… It also depends on the classroom as well. There's a lot of factors involved. I've had cases where my client is in a mainstream classroom with other neurotypical peers, and that looks different versus an ASD cluster.

And I know both are pretty intensive in their own right. I've been in both. I know, ASD classrooms could be tough depending on the teacher and depending on what they got going on in the classroom. But I also know a classroom full of neurotypical kids can also be tough. I've seen it both ways. So, like, my heart goes out to teachers. I know it's not easy, but I've always wanted to be able to support teachers more and, through teacher trainings and even through teacher trainings, I kind of feel like sometimes depending on the teacher and depending on what they know, it could be something that they don't want, it could be something that they're just like, oh, why are you trying to tell me how to do my job?

And it's kind of like, oh, I'm not trying to tell you. I'm just trying to give you tools to help you better understand my client. And if you want to apply those skills anywhere else, that's up to you. I'm not telling you what to do. But at the end of the day, I can't force a teacher to do it. And I think that's where we also have differences and our backgrounds where we come [from] because I could give the teacher the skills, but it's up to them to use it versus when you guys go in, you're in there and you're like, hey, this is, this is my job. I was contracted by the district to tell you that you gotta do things this way.

So that's where we, I guess it's a little trickier. But ultimately, when I'm in the classroom, I just want to do what I can to support. And if there's any great ways that help teachers collect data, I would love to know, because that goes a long way. You know, if I can give them the tools to better equip themselves in the classroom, I would love to share it with them and be able to help them as much as possible.

Yeah. Well, let's land this conversation on the “why”. I know we've kind of talked through all of the different kinds of caveats or other kinds of competing variables, but just all of the pressures and perspectives that happen around just the work that we're doing just to support the students. I think at the end of the day, there's just, like, there's that “why” factor of like, why do we actually need this data? Why are we actually aligning what we're doing with that data? Like, what is the meaningful piece of that? It's more than just so we can have well founded recommendations. It's more than so we can achieve funding from funders, right? Like, at the end of the day for you, why is it important to connect that data with than what we can do for students?

I need to know if I'm doing my job right. In all realness, I need to know if what we're doing is making the impact that we needed to make. I need to make sure that I have something to show, like, hey, like, his behaviors are going down and, hey, look, these replacement skills are being acquired. I need that information because it may not be something that is observable to the naked eye.

But if I have this data and it's all there and it's nicely shown, that's my way to be like, hey, this is the progress. This is also something I could show to caregivers. I'm like, hey, look, ever since we got into their classroom, this is how he's been doing. Look at the behaviors. You see the condition change line. This is when we jumped in. Everything just dropped down. It's our way to see if what we're doing is effective. It's our way to make sure that we are reaching those meaningful outcomes and helping our clients. And not only our clients, also the teachers have the support that they need, and the school as well. We're there to help everybody. 

So that is the “why” for me, like, the “why” is to show that, hey, we're here, we're doing what we got to do, and we're making the impact that we told you guys we'd make.

So good. Well, thank you so much for sharing this. I know you and I kind of come from different perspectives on where this practice really fits in, but thank you for sharing it, because I think this is a perspective that isn't always brought forward into the educational space. Although so many of our service providers are living in this world, I just really appreciate you bringing that part to the conversation. Thanks.

Yeah. Thank you for having me.