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Addressing Health Equity in ABA Treatment Part I: A Black Mother’s Experience

LEARN is committed to fostering a culture that embraces what makes us each unique—be it race, ethnicity, gender/gender identity, sexual orientation, religion, national origin, disabilities/abilities, or socioeconomic background. LEARN aims to acknowledge the lived experiences and diversity of perspectives of our staff and welcomes our teammates to share their story to help foster conversations about diversity, equity and inclusion in our communities.

By: Asia Johnson, BCaBA, Autism Spectrum Therapies

Asia Johnson (she, her, hers) is an Assistant Behavior Analyst in AST’s greater New Orleans, Louisiana region and the co-chair of LEARN Behavioral’s DEI Employee Resource Group.

Walking on her tiptoes was interesting but cute. Rocking back and forwards raised my eyebrows. But the repetitive “I’m going to stop, I’m going to stop,” felt like weights pulling on my heart.

I had never heard the word autistic before. Little did I know that in a matter of months, the diagnosis of autism spectrum disorder (ASD) would be commonplace. I would sit in my living room with tears in my eyes and my phone in hand watching my daughter attempt to self-regulate. I felt helpless. For days this cycle would continue, leaving me uncertain if I was a good mother. I revisited each trimester of my pregnancy, actively attempting to re-evaluate anything I may have done wrong.

A mom of two with limited resources but a Medicaid card ready to go, I assumed it would be a walk in the park to get my daughter evaluated. I naively thought they would immediately tell me what was causing the concerns and provide tools to assist her. I imagined myself falling backwards into a hammock free from the weight of the world only to fall through the very net I assumed would hold me up. I was told there would be a nine-month wait before I’d receive a call about the evaluation. I was devasted. Even more, devasted to learn that if I had private insurance, I could have achieved a diagnosis in a few weeks.

As a Black woman who experienced medical malpractice during my pregnancies, I was on edge. I wasn’t sure I could trust clinicians to have my best interest at heart, let alone my child’s. With the pending evaluation, I wanted help but preferred help from someone who looked more like me. I kept wondering how a white female could relate to my child or me. Culturally we are different, from the way we comb our hair to how we greet another person.

When diagnosis day finally arrived, I was elated to put a name to all the restless nights. My daughter was diagnosed with autism spectrum disorder. I left that day with reassurance that I was indeed on the right track. But as I toured different facilities, I did not see anyone that looked like us. This feeling left me disappointed. No one in my family had walked this path, so I had no help with guidance or insight, but I was determined to obtain some help. As a parent, we are tasked with some minor and some major decisions to make on our children’s behalf; making the natural choice to seek applied behavior analysis (ABA) services was a significant decision in my eyes.

While I was grateful and relieved to finally have a diagnosis, I soon had a new concern. I quickly learned that the field of ABA lacked diversity within leadership roles. The most recent demographic data report by the Behavior Analyst Certification Board (BACB), reports 70.05% of certificants are white, with the remaining identifying as Latinx (10.56%), Asian (6.85%), Black (3.93%), Pacific Islander (0.38%), and American Indiana (0.28%).

My daughter’s primary struggle was with receptive communication. She could speak but would often talk at people. Her conversations would lead to questions she overheard on television: “Did you know your heart is located in your diaphragm?” However, my child was rarely truly interested in the actual response; if she was, she didn’t wait long to receive the answer before jumping in with another medically driven question. It seemed as if her focus was on the oohs and ahhs or the “wow, how smart” conversations that would follow.

ABA was described to me as a treatment option using empirical studies to promote behavior changes among people living with autism spectrum disorder (ASD). ABA included various treatment settings, and my daughter was provided two options. Option one was to have a behavior technician come into our home. The clinician explained how they would use ABA practices to decrease her comorbid diagnosis of sibling rivalry. Option two was an after-school social skills group to target her ability to reciprocate verbal responses when communicating with others. However, both did not resonate with my lifestyle nor my views as a Black parent, especially with the syntactic structures and linguistics I noted in our brief conversation. I often wondered if my family’s values would be accepted or would I have to have a practitioner come into my home and encourage their societal norms, and that was not something I was willing to accept. As a single mom, I also pondered how I would be able to bring my daughter to a social skills group while working a full-time entry-level job.

I wasn’t wrong to worry. Research shows that Black Indigenous Persons of Color (BIPOC) families and those of low socioeconomic status may encounter issues with inappropriate treatment delivery because of different cultural perspectives. I knew BIPOC families receiving treatment from white practitioners could often face implicit biases because of the country’s systematic racism, which frightened me. Unfortunately, the data says  white clinicians are likely to make assumptions regarding treatment based on stereotypes and their own lived experiences, leading to inaccurate recommendations. So, I did not move forward with ABA services. I did not feel any facility I visited had clinicians who knew how to properly teach my brown-skinned child how to speak the English language, consistent with my families’ syntactic structures.

This pivotal moment in my life shifted my perspectives and my professional journey. I decided that I could (and would) become the Black clinician I once sought. My journey has been harrowing, and often times I still feel like I remain the elephant in the room. But today, there is a peek of light at the end of the tunnel.

When parents embark on a journey designed to make socially significant changes in their child’s life, resistance is likely to happen when approached by a white clinician – especially in southern regions. The south has been known for racial divides and limited resources for Black communities. Southern states have long represented large Black populations and are often referred to as the Black Belt.  Nonetheless, Black patients continue to fight a battle for health equity and justice. ABA services are no different; the Journal of Autism & Developmental Disorders found that African-American children with autism were diagnosed an average of 1.4 years later than white children and spent eight more months in mental health treatment before being diagnosed.

BIPOC patients deserve support in their fight for equal services. BIPOC patients deserve consideration when formingeffective treatment plans. After a long road to a proper diagnosis, families should not face additional challenges in teaching their children the tools necessary for productive and responsible citizenship consistent with their cultures.

My goal as a clinician has always been to inform the world of societal differences that may impact treatment modalities. One example is the lack of acknowledgment often witnessed when practitioners teach verbal and behavioral skills. Often, Black individuals are forced to code-switch. When practitioners not familiar with the cultural nuances in language, work in some homes, they may dictate using what they are familiar with. Code-switching is exhausting, yet many Black individuals are forced to use the “standard language” society deems acceptable in a field focused on effective treatment. As a Black woman, I’m aware of this struggle (and have had to do it in my own life and work). I’m even more aware and conscious that it may be more challenging for those who are autistic to change their behavior readily, let alone the spoken language they are accustomed to hearing.

My experience as a Black Medicaid recipient who crossed various obstacles with my daughter’s diagnosis and treatment process encouraged me to seek out a company devoted to expanding diversity when I finally received my certifications. I am now a Black clinician striving for continued growth with ABA services in the south. I am hopeful for change as I continue to acknowledge cultural differences within my treatment plans.

LEARN pledges to create a community centered around trust, respect, tolerance, and empathy. Read more about LEARN’s DEI journey in our 2021-22 DEI Annual Report and find out how we are investing in our clinicians cultural competence and increasing the diversity of our clinical team. Together, we’re better.

Spotlight on Diversity in ABA: An Interview with Joshua Polanco

A board certified behavior analyst (BCBA), managing technician, at LEARN’s Autism Spectrum Therapies (AST) in California’s Inland Empire region, Joshua Polanco provides supervision and behavioral intervention plans for clients in need of ABA services. He earned a master’s degree in psychology and ventured into ABA because he wanted to use that degree in a more direct and meaningful way. He’s also legally blind.

Here, he shares stories from his journey and experience working with children and young adults with autism—and his take on the importance of diversity, equity, and inclusion (DEI) in the field of applied behavior analysis (ABA).

 

Q: WHY DID YOU GET INTO ABA?

A: I was working as a behavioral technician and providing one-to-one services with multiple clients. I was about to quit after the first two weeks of working in the ABA setting because I did not have any experience with children with disabilities and felt like I was not helping my clients. Ironically, the clients and their families are what made me stay. To me, nothing can beat the sensation of knowing you have made a difference in someone’s life, and I have had so many fun experiences that helped me realize the importance of ABA, and how prevalent it is in our everyday lives. All of these experiences are what drove me to continue pursuing ABA to the position where I am now.

 

Q: WHAT DOES DIVERSITY, EQUITY, AND INCLUSION (DEI) MEAN TO YOU?

A: Everything. I feel these concepts as a whole are very overlooked at times. It’s not only important to have diversity, equity, and inclusion in the workplace but to also recognize the benefits provided when DEI is incorporated into a work environment. In my case, I may be legally blind, but that does not make me useless in a work environment that relies heavily on vision. I am able to continue to make an impact on peoples’ lives through my work and can actually provide a different perspective and understanding when helping clients or co-workers because of my loss of vision.

Q: IN YOUR OPINION, WHAT IS THE MOST CHALLENGING ASPECT OF WORKING IN A DIVERSE ENVIRONMENT?

A: Trying to comprehend various interactions that take place. Balancing the state of empathy and understanding, while simultaneously needing to support and accomplish work objectives that need to be achieved.

Q: WHAT IS YOUR APPROACH TO UNDERSTANDING THE PERSPECTIVES OF COLLEAGUES OR CLIENTS FROM DIFFERENT BACKGROUNDS?

A: The short, easy answer is that I take a step back and just listen. Self-awareness and self-control over your own biases and habits go a long way. It’s important to me to recognize the limitations you have in the moment. For example, you may not always be able to truly understand the perspective of others. This is OK—we are only human. I feel like there are ways to still attempt to understand to some degree. Failure to truly understand someone should not give us permission to disregard their perspective.

I’ve relied, to some degree, on multiple psychology books, articles, and notes from when I obtained my master’s degree in psychology, with an emphasis in clinical counseling and marriage and family therapy. When communicating with colleagues and clients, I always try to review and remember the concepts I learned on the dynamics of communication, including those on cognitive distortions and positive feedback loops. Understanding these can play a huge role on how I understand and communicate during a conversation.

Q: WHY IS DEI IMPORTANT IN ABA?

A: Without DEI, we would be refusing to grow ABA as a whole. ABA is a science that expands to more than any one individual population. Part of everything we do is to help, expand, and make a difference in the world. What better way to accomplish this than to recognize the different things people have to contribute.

Q: TELL ME ABOUT A TIME WHEN YOU ADVOCATED FOR DIVERSITY AND INCLUSION IN THE WORKPLACE OR IN YOUR PERSONAL LIFE.

A: One poignant instance in which I had to advocate for myself is the moment I was officially diagnosed blind, and I had to reach out to the HR department to figure out some resolutions and next steps forward. Luckily, I was part of a supportive team and was able to continue doing the core work I was educated to do and hired for, with some slight accommodations and adjustments.

Q: WHAT’S SOMETHING MOST COLLEAGUES DON’T KNOW ABOUT YOU?

A: I do not know how many people know that I am legally blind. My condition is called Retinitis Pigmentosa (RP). There is no treatment. With this condition, my vision will gradually worsen. There is no telling how much vision I will lose tomorrow…or over the next 30 years. I don’t only have to think about how this affects the work I do with clients but how I adjust my everyday life to prepare for this. Through my work with rehabilitation specialists, I am learning to use technology, to read braille, and even to cook without looking.

Q: ANYTHING ELSE YOU’D LIKE TO ADD?

A: I was diagnosed legally blind less than a year ago. In that time, I’ve taken and passed the BCBA exam, which was the first test I’ve ever had to study for and take without my vision, while finding ways to balance my work, as I learn a new lifestyle. I hope the message from all of this is one of inspiration—that no matter how bad things may seem, it’s important not to let the events around you, define you. Take control of the things you can, adapt, and persevere through the adversity. Because this is what we ask of our clients each day.

For more from our Spotlight on Diversity in ABA series, read “An Interview with Angela Parker.”

Spotlight on Diversity in ABA: An Interview with Angela Parker

Passionate about improving the lives of kids with autism and their families, Angela Parker works as a board certified behavior analyst (BCBA) for Autism Spectrum Therapies (AST) in California’s San Gabriel Valley region. She and her team of 17 are committed to the consistent, ethical use of the programs AST and LEARN provide. In this interview, she discusses her experiences in ABA and her involvement with AST and LEARN’s Diversity, Equity, and Inclusion (DEI) Plan, a longstanding commitment to fostering a culture that embraces what makes us each unique.

Q: WHY DID YOU GET INTO ABA?

A: I took a course during undergrad called “Through Another’s Eyes, where I volunteered at a company that hired adults who were disabled prior to age 18. It changed my worldview, and I stayed on longer to complete an internship there. Following graduation, I started as a 1:1 paraprofessional in a school district and learned how to run a Discrete Trial Training (DTT) session. Realizing how much I loved these two experiences, and how much I loved working with this clientele, I decided to look into working full-time in ABA.

Q: WHAT DOES DIVERSITY, EQUITY, AND INCLUSION (DEI) MEAN TO YOU?

A: Diversity helps me understand someone else’s perspective. Diverse representation on my team and caseload teaches me various aspects of cultures I may not have been otherwise exposed to. Inclusion encourages me to be more aware, to look at how environments can and should create safer spaces, depending on—and regardless of—background. Equity reminds me that I should make sure I develop these safe spaces for my clients, for the staff I mentor, and for the colleagues with whom I interact.

Q: WHAT IS THE MOST CHALLENGING ASPECT OF WORKING IN A DIVERSE ENVIRONMENT?

A: It’s ensuring I am culturally competent regarding the people I interact with daily, which involves being mindful of the impact my actions have on those around me.

Q: WHAT IS YOUR APPROACH TO UNDERSTANDING THE PERSPECTIVES OF COLLEAGUES OR CLIENTS FROM DIFFERENT BACKGROUNDS?

A: I tend to ask clients or staff questions so I can learn if they are doing something I have never been exposed to or am not familiar with. An example that sticks with me is a time I worked with a Hindu family celebrating Diwali. I was curious about what the various decorations symbolized, if the family would need to take time off for festivities, how the holiday was developed, and its importance in their culture. Learning about all of this not only helped me in my role but also taught me something new.

I also tend to check in with parents regarding social skills and if, in their culture, certain skills are acceptable skill to teach. For example, a Nigerian client shared how expectations of children when responding to adults in their culture counters typical Western responses, such as the Western habit of looking at adults in the face. Another family shared that it is not customary for children in their culture to ever call their parents by their first names or know parents as anything other than ‘mom’ or ‘dad.’

Q: WHY IS DEI IMPORTANT IN ABA?

A: DEI is important in ABA because as clinicians, we want to promote inclusivity across any background or way of life. I try to focus my practice on being mindful of every client and family’s situation. This involves being as sensitive as I can to promote success, while also understanding potential limitations. I try to model for my staff how to be culturally curious and respectful of family dynamics. And I always remind them that just because we’ve had an experience with people of a certain background, it doesn’t mean a new family with the same background will respond or have the same cultural preferences. Everyone is unique, and it’s our job to respect that.

Q: TELL ME ABOUT A TIME WHEN YOU ADVOCATED FOR DIVERSITY AND INCLUSION.

A: Once, on an outing with a client to practice tolerating using hand-drying machines, my client had a difficult time with the noise. A staff member asked us to leave because my client was having a tantrum. I asked the parent if they were OK with me speaking to the manager for them, which they were. After session, I returned to the store to speak to the manager and explain what we were doing. The manager understood, and moving forward, the staff always greeted us, and the parent felt more at ease because they did not feel as judged by the staff during our daily outings.

Q: WHAT’S SOMETHING MOST COLLEAGUES DON’T KNOW ABOUT YOU?

A: Most people know that I come from a large family (four sisters and two brothers), but they don’t know that I come from a blended family. I say I have six siblings, but in reality, others may say: ‘Oh those are your step-sisters, your half-sisters, your adopted brother. They’re not really your siblings.’ Statements like this can be extremely harmful, because growing up, we never labeled one another that way. It was even harder because my one full biological brother looks like the complete opposite of me. I have my mother’s light features: light eyes, light skin, light hair, while my brother has my father’s features: dark hair, olive skin, dark eyes, because we are multi-racial. Statements questioning family relations create divides and identity issues that aren’t necessary. All I ever think when this happens is: ‘This is just my family, and I am surrounded by love. Is that not enough?’

For another story from our series, Spotlight on Diversity in ABA, read “An Interview with Giovanna ‘G’ Bosco.”

Spotlight on Diversity in ABA: An Interview with Giovanna “G” Bosco

Giovanna “G” Bosco (she/they), a training tech at LEARN Behavioral and AST’s Mandeville, Louisiana, location, spends the bulk of their days preparing and onboarding staff to join the LEARN and AST team. When a friend from another AST region mentioned the open position, G’s love of being around children prompted her to apply. Then, after the job offer arrived, they jumped at the chance to work with kids regularly—and spend her days making a difference in the lives of others.

G took time recently to talk about their work with LEARN’s Diversity, Equity, and Inclusion (DEI) Plan, along with her experience working in ABA at AST. Here, we share the conversation.

Q: What does Diversity, Equity, and Inclusion (DEI) mean to you:

A: To me, diversity is an adjective I use to describe the environment in which I like to place myself. When I think about those individuals I call my friends, co-workers, and fellow community members, I think about how no single person is like another. We each look different, have different social histories, and may even differ on how we function neurologically. Although we may be different from one another, I can learn from each of them things that I would never know if I only surrounded myself with people who look and act like me.

Equity is about establishing a level playing field. I am aware of the privilege I have, and it isn’t enough to ask that those who were not born into same privilege be treated equal. I want everyone to have access to the resources that will ensure everyone has the same fighting chance to be successful in life. Inclusion, or to include others, is an action I decide to do each day. It involves creating an environment that welcomes others and makes them feel safe and secure.

Q: In your opinion, what is the most challenging aspect of working in a diverse environment?

A: Where I live, in Louisiana, the population isn’t all that diverse. So, the most challenging aspect I could identify is in communication, and how I work and relate with new hires who come through training. But recognizing the role communication plays in any interaction with another person is probably a challenge we could all benefit from realizing and thinking more about. As I mentioned, we all have our own differences (internal and external), and recognizing and appreciating that can go a long way. But it’s not always the most intuitive thing to do.

Q: What is your approach to understanding the perspectives of colleagues or clients from different backgrounds?

A: I think the most important thing to do is to create a safe space where people can come forward and explain their perspective on the situation. We might all have different ideas on how to complete tasks or how to address certain situations, but if those involved and I are respectful and open of other ideas, a solution can almost always be found.

Q: Why is DEI important in ABA?

A: In our line of work, it is never just about the diagnosis. Our clients are diverse racially, religiously, and in so many other ways. These social identities will always intersect with their diagnosis, and you cannot serve a client without addressing all of the factors that make them them. So, I think DEI in ABA is important for many reasons. Having a diverse staff can help improve the services we give to our clients and their families … and having staff who are self-aware and willing to learn about each client’s culture will only help us provide quality services. DEI can make us all better colleagues, friends, and neighbors, too.

Q: Tell me about a time when you advocated for diversity and inclusion in the workplace or in your personal life.

A: This one is difficult for me because I don’t truly feel like I’ve advocated for this in the workplace or in my personal life. It’s something that’s just felt inherent—this is coming from someone who always received the citizenship award growing up because I was friendly to everyone. So, I may not be so intentional on acting on it. It started with something my mom always told me: “If you see someone sitting alone, sit with them, even if they don’t want to talk.” I think, overall, that’s a pretty great starting point.

Q: What’s something most colleagues don’t know about you?

A: Most of my wonderful co-workers know that I have a beautiful wife and am part of the LGBTQIA+ community. However, something most of my colleagues don’t know about me is that I identify as non-binary.

To find out how and why we tailor ABA treatment to the unique needs and values of every client and family, read “Perspectives: Embracing Individuality in Behavior Analysis.”

Spotlight on Black Professionals in ABA: Maia Jackson

Our new series, “Spotlight on Black Professionals in ABA,” continues with an interview with Maia Jackson, the clinical development manager of LEARN Behavioral’s Autism Spectrum Therapies (AST) office in Oakland, California, in the East Bay region of the San Francisco Bay Area.

The series comes on the heels of an analysis conducted by the Behavior Analyst Certification Board (BACB), which found that Black behavior analysts make up only 3.6 percent of the total board certified behavior analysts, a number that lags behind the 13.4 percent of Black people living in the United States, according to 2019 U.S. Census data.

Here, Maia talks about her experience and the critical need for mentorship in the ABA field.

Q: Thanks, Maia, for taking time to chat with us. Let’s start with the beginning: how did you get into ABA? What attracted you to the field?

A: My senior year in college at Sacramento State University, I still didn’t know what I was going to do. I majored in psychology, which is kind of general. As I got closer to graduating, I went on Craigslist—that’s a sign of my age—and saw a job posting that said, “Work with kids!” I really enjoyed kids and thought, Why not? I ended up taking the job and doing direct intervention with four- and five-year-old kids with autism spectrum disorder (ASD). They were adorable.

After a few months of that, I knew I wanted to continue but in a way that allowed me to grow in the field. I started Googling and looking at various options for graduate school, ultimately enrolling in National University’s master’s program in education, which offered a specialization in ABA.

Q: What was graduate school like for you?

A: It was an interesting, though busy, experience. I kept my job with Bridges, an ABA provider in Sacramento, and juggled work with studying. It helped that most of my courses were online, but that also made it harder to make connections and interact with my peers and professors. My studies lasted about a year and a half, and when I graduated, in 2009, I needed a board certified behavior analyst (BCBA) to observe and supervise me in the clinic for a set number of hours, in order to earn my own credentials as a BCBA. But ABA was still a relatively new field, at least in regard to autism, and I couldn’t find anyone to supervise me. There just weren’t that many BCBAs around at that time.

In 2011, I ended up taking a job with AST, which had recently opened a new office in the Bay area. The office caseload grew quickly, which was exciting but also challenging—I was thrown into the mix. There was a learning curve, but I got the supervision and support I needed to earn my BCBA certification and ultimately help kids and succeed in the position.

Q: What was the supervisory experience like for you? What kind of feedback did you receive on your work in the clinic?  

Someone from one of AST’s more established offices in southern California drove up to supervise me, and that was a real game-changer. I came to think of her as my mentor. In fact, I didn’t know what I had been missing until I had someone come in and provide that level of support. Mostly, what she gave me was time—time to sit and listen as I talked about my cases, time to answer my questions, time to trouble shoot. I hadn’t had that level of support before. She gave me her input and clinical guidance and expertise. Plus, she was a woman of color, like me, and I hadn’t worked with a woman of color in ABA until that time, even in grad school. She gave me the confidence to express my thoughts and concerns about the job, and advice on how to balance my professional and personal lives. We still keep in touch and call each other to troubleshoot or even just catch up.

Q: It sounds like the relationship with your mentor was a game changer, indeed. How has that experience influenced your continued work in behavior analysis?

A: Well, right now I work as the clinical development manager, supporting newly hired trainers and providing training to new supervisors, so my job, essentially, is to help guide and support new employees in clinical positions. This is important because the better trained we are, and the more we feel supported in our positions, the better the outcomes for our clients and the higher retention rates for our team.

I’m also part of a team of five professionals at LEARN launching a mentorship program for employees taking part in our organization’s Future Leaders Diversity Advancement Program Cohort, designed to increase the number of Black BCBAs at LEARN. The program provides financial assistance to employees attending National University’s master’s program in ABA. As I mentor, much of what I’ll do is what my mentor did for me—listen, guide, and help troubleshoot any problems that come along, whether related to the field or to things like work-life balance.

Mentoring is something I truly love doing. It differs from a supervisory role, where people might be guarded and careful with what they say. In a strong mentor relationship, people can pick up the phone and call anytime without worrying how they’ll be perceived. The focus is on building confidence, happiness, support, and growth.

Q: In your own words, why do you think it’s important to increase the number of Black professionals in ABA—and to increase diversity across the field, in general?

A: At LEARN and AST, we have a diverse clientele, though I’d like to see an even more diverse clientele—to see a broader range of children accessing services. Systemic issues prevent some children from getting the care they need. It often starts with well-baby checks, for instance, where a pediatrician might not refer patients who are Brown or Black to the appropriate resources in a timely manner or might not diagnose them early enough. Difficulties with transportation, work schedules (with parents working multiple shifts), and funding also prevent some children from getting the care they need. Plus, not everyone can afford services. Even with insurance, a $40 to $45 co-pay several days a week adds up quickly.

Early diagnosis and intervention are also critical. Studies show that Black and Hispanic children are diagnosed later than white children. We need to do more to make sure all children are diagnosed as early as possible so they can take advantage of the benefits of early invention. Increasing diversity among BCBAs, who can go out in the community and conduct parent and caregiver workshops, while raising awareness to pediatricians and other people in the community, are key to better serving the broad range of children in need. LEARN’s partnerships and community liaison team are doing that important work, and I would love to join and support their effort going forward.

Read the first interview in this series, “Spotlight on Black Professionals in ABA: Brandon Whitfield,” and find out more about our Diversity, Equity, and Inclusion Plan.

Spotlight on Black Professionals in ABA: Brandon Whitfield

Our new series, “Spotlight on Black Professionals in ABA,” kicks off with an interview with Brandon Whitfield, the clinical director overseeing LEARN Behavioral’s Autism Spectrum Therapies (AST) Beach Cities office in beautiful, sunny Los Angeles.

This series comes on the heels of an analysis conducted by the Behavior Analyst Certification Board (BACB), which found that Black behavior analysts make up only 3.6 percent of the total board certified behavior analysts, a number that lags behind the 13.4 percent of Black people living in the United States, according to 2019 U.S. Census data. To put this in perspective, this equates to roughly one Black behavior analyst for every 28, compared to a population of roughly one Black person for every eight people in the United States.

Here, Brandon sits down to talk about his efforts to help boost diversity and share stories about his experience in the field.

Q: Brandon, thanks for taking time to talk with us. You recently served on a panel of speakers for a webinar, “Racial Equity in ABA,” at the University of Southern California – Dornsife. How did you get involved?

A: Well, it was really coincidental. During a Harbor Regional Center vendor advisory committee meeting with other behavioral health agencies, I asked for updates on what they were doing to address diversity concerns. In a previous meeting, they had discussed some agendas surrounding action items for diversity, and I wanted to find out what was happening. A colleague from Harbor Regional Center heard me ask the question and later reached out to talk to me about her involvement with the “Racial Equity in ABA” event at USC – Dornsife. We hit it off from there, with both of us seeing a real need to diversify the field and make the pool of clinicians more reflective of the children and individuals with autism in need of treatment.

Q: You’ve been at AST for 12 years now. How did you get into the ABA field?

A: That’s a fun story—and a long story because it spans my entire working life. In college, I worked for a company as part of their mobile crisis intervention unit for adolescents and adults. I was assigned to a 13-year-old boy with autism who had severe behaviors, and I thought to myself: How did he reach the point of needing a 24-hour crisis service? I started researching and learning about autism, knowing there had to be a better way.

After wrapping up undergrad, my dad, a school psychologist, introduced me to his intern, who worked for AST. One thing led to another, and I started as a behavior technician on May 5, 2009. I’ve been here ever since.

Q: Tell us about your experience as a behavior technician (BT). How did it inspire you to continue in the ABA field?

A: Working as a BT was an eye-opening and rewarding experience. I started off as a BT in the classroom, where I realized I could affect change not only with the single child I was assigned to but also with his peers.

I remember taking my client to the playground and exposing him to social opportunities while playing kickball and basketball. He didn’t have the skills to socialize successfully, but I could see the desire to play and engage with his peers. So, it gave me a real purpose—to help him build the skills to get out there and play and socialize successfully. And with time, he did.

I was also motivated by watching his peers grow. Really quickly, they realized that it was OK to play with kids with special needs. Stereotypes washed away, the more time they spent together.

Q: That’s a great story, and I love the line “stereotypes washed away.” How does the story continue? In other words, what prompted you to become a behavior analyst?

A: As a BT, the research always intrigued me. I read some studies from UCLA that showed how peers could be involved and help with autism treatment, specifically with social skills. So, I got to read about what I saw happening firsthand.

My supervisors also played a role. I started getting access to parents on home cases and began helping to implement parent education goals. I really liked that interaction and started reading about it. I borrowed the classic ABA textbook from a friend—”the Cooper book,” we call it in the field. It’s by John Cooper and some other scholars from Ohio State University. Most people would fall asleep with all the scientific jargon, but I loved it. I ended up using it as a supplement to help parents and caregivers. I even made copies of certain chapters for the parents to review with me during sessions.

My supervisor noticed my extra steps and encouraged me to pursue a master’s degree and earn my BCBA. I told myself, “This is what I’m meant to do.” And I did it. Eventually, I was promoted to a program supervisor position. I worked 40 hours a week as a program supervisor, plus weekends at a group home. I spent every spare minute studying.

Q: That sounds like a busy schedule, but your hard work paid off. Tell us about your first months as a behavior analyst?

A: I started with a pretty challenging caseload—10 cases. But I felt more independent, more grown-up. Sure, I needed to work on time management and staff management, but I cherished the level of influence that I had gained over the treatment planning for the cases I was assigned. I really liked that.  The one difference that was really pronounced for me: within what felt like a day, I went from being people’s peer to being their supervisor. It was an adjustment, but I really enjoyed working with my team and growing together.

Q: It sounds like you were a natural, given that you’re now a clinical director. What are some of your future goals as a leader in the ABA field, both in general and in your involvement with LEARN’s Diversity, Equity, and Inclusion (DEI) Plan?

A: In general, I’m itching to get back to my community outreach, which has largely been upended by COVID. It’s something we’ve been passionate about in our region and something that works—using community outreach to increase awareness of ABA in communities of color. Tremendously large communities are underserved in our area, so I’d really like to change that—from a diagnostic standpoint to access to early intervention.

Of course, I’m really excited about LEARN’s DEI efforts. Beyond LEARN’s Future Leaders Diversity Advancement Program, we’re exploring the possibility of establishing affinity groups within our organization. Affinity groups essentially provide a safe space for employees who are members of marginalized groups to come and talk, problem-solve, and get support for issues that relate to diversity, equity, and career development. Efforts the DEI group is making as a whole really reflects LEARN’s dedication to securing a more diverse, equitable, and inclusive future. The conversations taking place are important, and I hope they’ll spark more people to jump into the fray.

Perspectives: Why Access to ABA Is a Matter of Social Justice

By Nathan Franklin
Managing Behavioral Treatment Technician, WEAP, Milwaukee

As our country starts the process of distributing vaccines for COVID-19 and re-opening our cities, many people are hoping that 2021 delivers a return to normal. We are getting that first glimpse of a promising horizon. But instead of trying to return to the old normal, we have a chance to establish a new and better normal, informed by the experiences of the past year.

The coronavirus pandemic brought many new problems to our lives in 2020, but it also exposed problems that have long existed, particularly the racial inequities that are so deeply and structurally rooted in our country.

One of the more well-documented areas of racial disparities is in the area of health care, including behavioral treatment for autism spectrum disorder (ASD), with which I am personally involved. I’ve spent the last 10-plus years providing applied behavior analysis (ABA) therapy to children with autism in Milwaukee at Wisconsin Early Autism Project (WEAP). Studies show that Black and Hispanic children are diagnosed with autism at an older age than white children, are more likely to be misdiagnosed initially, and are less likely to receive an accurate diagnosis at all. Because the best outcomes for children with ASD depend heavily on early diagnosis and treatment, reading these studies was revealing—and brought the issues of racial justice to the forefront of my personal focus.

As a white man working with many children and families of color, I find the reality of a delayed or even absent diagnosis alarming and upsetting—and consider access to ABA a social justice issue that I can personally and directly help address. While I realize the causes of these disparities are complex and must be understood through a larger lens of historic and systemic racism in our societal institutions, I believe we can all make progress addressing these inequalities by starting in our own circles to seek understanding and solutions.

The good news is that by many measurements, the diagnosis gap is beginning to show signs that it is closing, though the problem is far from solved. Getting a diagnosis is only the first step, however, after which actually accessing the necessary services is key. And here again, race, ethnicity, and socioeconomic status can affect access to treatment and the quality of treatment.

For a long time, I took for granted that the vast majority of children I’ve worked with have been Medicaid-funded. Unfortunately, many providers simply do not accept Medicaid clients. While I’m grateful to work for a company that is the exception to that rule, I would call on the federal government, state government, and providers to do more to increase access to services. No one should be denied services because of their income, and since the economic disparities in this country are tied to historic and structural racism, it is not just a matter of social justice but also racial justice to ensure that quality treatment is available to everyone who needs it.

There are other obstacles that can contribute to the lack of access to ABA. For example, many ABA services take place in a client’s home, creating an unintentional barrier for working families, given that home-based services require the presence of a parent or guardian. For families who need multiple people working multiple jobs just to make ends meet, this requirement alone can prevent them from accessing services.

One possible solution is to provide opportunities for treatment that children can receive without their parent or caregiver. In the beginning of 2021, WEAP opened a learning center in the city of Milwaukee, giving communities of color the more convenient access they didn’t previously have but needed. Access is important, and the difference between travelling across a city and having resources in your own neighborhood can be the difference between receiving services—and not.

The services provided for children with ASD are no exception to the general rule of racial inequities, though the research and our understanding are only beginning to develop. For anyone inclined towards research, this is an open invitation to look into these issues more deeply. The experiences of the past year have given us new perspectives to understand that solving a widespread problem requires a combination of research, structural changes, and personal responsibility to do our part in our own worlds. For those of us heavily involved in the world of ASD, this historic opportunity to pursue a new and better normal calls on us to recognize, understand, and address the injustices in our field—and to act with a sense of urgency to ensure that our treatment options continue to improve not only in quality but also in equality.

How to Start Talking About Racism

By: Angela Montes, MS, BCBA

 

Racism. Its existence makes our hearts heavy, evokes sadness, generates uncertainty, and creates fear. Starting and having a conversation about racism has always been difficult. Even though it may make us uncomfortable, it’s an important conversation to have. As parents and caregivers, you may find yourself asking: How old does my child need to be to have this conversation? How do I even start the conversation? Are there any resources that will help me with this conversation? Here are some starting points, using some of the tools you might already have, to initiate a conversation about racism.

 

Ages 0-2:

It is recommended that children see their parents and caregiver interact with individuals whose race and ethnicity differ from their own. Take it a step further and enrich your environment to ensure that your child is exposed to books and toys that include multiple ethnicities. According to studies (Kelly, D.J., et al. 2005), children as young as three months old can categorize people by race. Early intervention is critical.

 

Children’s Books about Diversity

 

Ages 3-4:

Between this age, parents should continue to model inclusivity of other ethnicities via physical interactions, TV shows, books read, and toys purchased. Children who see their parents and caregivers engage in unbiased behavior benefit from the positive model they observe. As a proactive strategy, initiate the conversation of racism with your child by pointing out the differences in color of skin, hair, and language. It is important to show young children that differences exist and that it’s okay to be different.

 

10 Tips for Reading Picture Books with Children through a Race-Conscious Lens

 

Ages 5-11:

Between this age range, children are making stronger associations across racial groups. Continue the exposure of multiple ethnicities via books, TV shows, and interactions. Initiate a discussion about the subtleties within TV shows and how stereotypes often carry over into the real world. Begin to discuss how racism has created an unfair treatment of people of different

races. Continue the conversation that this issue has been ongoing and that they can help support the fight against racism through advocacy groups. Having direct conversations during this age can help improve racial attitudes. As a proactive strategy, parents and caregivers can begin conversations about racism early and not wait until their child is exposed to a racist event.

 

CNN/Sesame Street racism town hall

 

Ages 12 and up:

Keep the conversation going! During this time, continue to model interactions with other ethnicities, diversity within books, games, and TV shows. Remain open in dialogue, including answering questions children have about racism (even if it’s uncomfortable for you). These direct conversations promote inclusion and that it’s okay to discuss racism within your family structure. In doing so, you are providing different perspectives for your children. Teach your children how to recognize racism and how to respond to situations they may encounter. For example, you can equip your child with statements to use, such as “I don’t agree with you,” or “that wasn’t cool – because…” Additionally, ensure your child knows whom they can approach to report and discuss what they experienced. Using age-appropriate language, ensure that children also have the skill of self-awareness regarding race. From evaluation, that is your starting point to begin to educate your children on what race is and what it isn’t.

 

How to Talk to Your Kids About Anti-Racism: A List of Resources

 

Resources
Studies on the topic of race

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2566511/

(Kelly, D. J., Quinn, P. C., Slater, A. M., Lee, K., Gibson, A.,

Smith, M., Ge, L., & Pascalis, O. (2005). Three-month-olds,

but not newborns, prefer own-race faces. Developmental

science, 8(6), F31–F36.

 

https://doi.org/10.1111/j.1467-7687.2005.0434a.x

 

https://www.academia.edu/3094721/Children_Are_Not_Colorblind_How_Young_Children_Learn_Race

 

 

Tools on How-To regarding racism

 

https://themighty.com/2015/04/what-to-do-when-kids-pointat-someone-in-public/

 

http://www.childrenscommunityschool.org/social-justiceresources/

 

https://centerracialjustice.org/resources/resources-fortalking-about-race-racism-and-racialized-violence-withkids/

 

https://www.embracerace.org/resources/10-tips-forreading-picture-books-with-children-through-a-raceconscious-lens

 

 

Resources to expand your library

 

https://akidsbookabout.com/

 

http://hereweeread.com/

 

https://bilingualkidspot.com/2019/05/13/diversity-booksfor-children

 

https://www.mylittlemoppet.com/books-about-diversityand-tolerance-for-young-kids/

A Letter From LEARN’s President

Over the last 10 weeks, I know that most of us have experienced some level of fear, sadness, uncertainty, and hardship as the pandemic has swept across the country and changed almost every facet of American living. For many of us, these feelings have been compounded in recent days with sorrow, anger, and confusion as civil unrest has forced us to look hard at the inequities in American society. Especially to members of the Black community that we work with and serve, I send my personal support and empathy, and I want to be clear that we stand in support of the rights, safety and dignity of all people.

As an organization, it’s periods like these that force us to think deeply about our role in creating a brighter future in the communities we serve. Inherent in our mission is the idea that we exist to help children succeed. But now more than ever, it’s important to take stock of who we help and how we do it. I believe strongly that:

  • Our mission is to deliver as much hope as we can, to as many families as we can, equally and fairly within all the communities we serve.
  • We have a duty to serve all families with compassion, respect and understanding of their circumstances.
  • While society as a whole may not be a level playing field, we must do better to create a workplace that is inviting, and model inclusion and diversity.

So, what’s next?

  1. We will be re-evaluating how we train and support the clinical competency of our clinical and administrative team to ensure that our services are compassionate for all
  2. We will be tasking our Diversity & Inclusion Committee with generating new ideas on how we can better promote a diverse and inclusive workplace
  3. We will continue to proactively seek to expand our services to underserved communities in need

Every step forward counts, and if we can make small progress every day towards our ideals, we can deliver results that will continue to make us proud to work for LEARN as we do our part to contribute to a brighter future for all.

#togetherwecan

-Justin

President, LEARN Behavioral