Compassion Before Compliance: Training Behaviour Analysts in Cultural Responsiveness

0:00And it's interesting that you're talking about episodic severity because that's one of the things like as soon as we start our services. One of the main things that we work towards is reducing that and which again, to reduce episodic severity, we would be using a lot of like reactive strategies to immediately deescalate and which would mean that you may want to deliver function reinforcers that are maintaining that behavior at like a precursor level so that it's not escalating to a point where in the person is getting injured or like is requiring hospitalization. So it's mainly like focusing on meeting the needs of the person as soon as possible early on in the chain of behavioral escalation, collaborate and consult with the person to understand what their perspective is or what the environment is or the context is. And in this process, we may also want to self reflect

1:01on our practice. In the sense, I may want to acknowledge what my culture believes values, biases are in relation to the services that I'm providing. I and also having that inside that I may want and expect the programming to be a certain way. But I need to see that in like a certain given context, am I being responsive to the other person's needs and the context. And then run and this is behavior. Today, my guest is pretty vocal, a BCBA researcher, supervisor and PhD candidate whose work sits at the intersection of compassionate care, cultural response in this and behavior analytic practice. Having worked both across India and Australia, pretty brings a unique international perspective to

2:03supporting individuals, families and practitioners. In this conversation, we explored the multi element behavior support framework, closely responsive service delivery, and her published research on teaching practitioners functional assessment interviewing, compassionate care and cultural response of skills. We also discuss why some of the most important skills in our work may not be the technical skills we learned in graduate school. Is you've ever wondered how to build stronger relationships with caregivers and prove your assessment practices or bring more compassion into your behavior analytic work. This is an episode you won't want to miss. Here's my conversation with pretty vocal pretty vocal welcome to the hammer speak. Hi, Ben. I'm excited to have you. Let's get right into it. So you've worked across India and Australia. Well, how'd you get into behavior analysis? So I am Indian by origin and I've worked in the field for about 14 years. We're in like the first seven years,

3:07or were in India and the next six in Australia. I'm currently based in Australia and I came to this field very randomly. So once I finished my masters in clinical psychology back in India, I started working in our school setting as a psychologist, wherein I was working as a learning support assistant, delivering like a life skills curriculum with some students with support needs using some behavior analytic principles, but they're not officially calling it as behavior analysis. I worked in that setting for about two years before moving to a specialist school setting, which solely delivered services to young children and adolescents, which severe problem behavior, who are not getting admissions in a mainstream school setting due to their severity of behaviors. Now, this

4:08school, it operated in collaboration with the New England Center for Children. It's a US based organization. And they have their setups in the Middle East as well. So at that time, this is back in 2014, 2015, they were flying over to BCBAs every couple of years to run the school. And that is the point when I was introduced to behavior analysis. I was the very first batch at my organization to get enrolled in a postmaster's coursework in behavior analysis from the Florida Institute of Technology, probably like the second person within my organization who got the certification back in 2017. And at that point in India, like they were around 300 certified practitioners with BCABA BCABA, ABA and RBT

5:10certification. I was also fortunate enough to receive my supervision hours while the place where I was working. So that was a really helpful thing in terms of getting myself certified. Now, I worked in this setting for about five years. At that time, I was managing a classroom with eight students, supervising and training the teachers on the floor, assisting some of them to get their certification for BCBA and RBT. And during this time, I also got some experience working in the home and communities setting. And following that, it was a personal decision to move to Australia for work. Now, in Australia, currently, I live in a small regional city. It's

6:14called Canberra. I'm not sure if you know about it. I've heard of it. How small is it? It's it's small in the sense that like you can go north to south of Canberra within like 30 to 45 minutes. So pretty small. It's it's it's all it's close to Sydney. And so again, very limited services hard to find practitioners within this region. So when I came to Australia, at that point in time, I continued to work with young children and adolescents, specifically working like in a clinic setting, but then also in other service settings where those participants needed supports, it could have been like home school, daycare community. And during this time, I was using a lot of Iskars, Kilber Street Bend, Universal Protocols, balance to support my participants with behaviors while teaching them the meaningful skills. And following that,

7:15like I further expanded my experience, working with individuals across age groups, got into implementing the Mebs framework. So it's the multi element behavior support framework developed by Lawick Nandvillis. So with this framework, it's basically uses a construction approach to improve a person's quality of life, wherein the meaningful skills I'll taught and behavior reduction would just be a byproduct. I'm currently working with this organization for like about four years now, I have some experience in implementing working with my participants, but then primarily supervising a team of practitioners and managing an office out here in Canaanra. In addition to this, I also do some research work for my current organization. And yep, and I'm also doing a PhD from the Chicago School. Wow. And

8:18been three years into it. That's amazing. Tell me, so you came to Australia not for work, but for other reasons. And did you go to that particular part of Australia for other reasons, not for work, or did you so were you sort of brought to Canberra and you had to sort of kind of find work after that? How do that all come together? Yeah, so I came to Australia for work. So I wasn't a work visa. So there was an organization that hired basically hired me and I moved here for work. Okay. And that's that's how I like got so I didn't really have to find work as a farm work before I moved here. Curious initially, how different were things going from India to Australia in terms of this kind of work? I would say the biggest shift for me in terms of move was around like the differences in the service to live remodels. So back in

9:18India, my the majority of the experience work experience that I had was mainly in a school setting briefly in home and community, but then mainly in a school setting where I was delivering intensive support to my participants, whereas when I moved here, it was more that support kind of reduced in the sense that I was probably like, supporting my participants for like less and less number of hours. So again, the change was more from like providing intensive to like, consultative services. And that was like some growth for me in terms of how do you plan services from intensive support to limited intensity? It was and I love to know more about mebs sort of like tell me a little bit about mebs and kind of how it might differ say from maybe traditional PBS and and sort of what what what what you

10:20seem I know you seem to like the construction aspects of it. So what drew you to that that approach? The thing about mebs that I liked the most, I mean, nothing about mebs is a new. It applies the principles of behavior analysis. The framework itself provides a structure to the people who have to implement it in a way that like there is. It provides like a detailed breakdown of what a comprehensive assessment may need to include over that can look like. And this is where again, you may go into depth in terms of understanding what the person's needs are, what their background is, you will conduct an assessment for the behaviors. But then you will also try attempt to understand what their ecology

11:21would look like in the sense that how their physical environment interpersonal, programmatic environment, how is that set up? What the matches or mismatches are within their environment? So it's it's basically a not just looking at immediate contingencies, you're looking at the whole environment, what the person's experiences have been like. And from all that information that you are getting, you are then working towards developing function based intervention. The intervention itself, like again, the framework breaks it breaks it down into proactive and reactive strategies. Proactive would focus more on preventive reinforcement based, having reinforcement based schedules, but then also looking at ways to teach those functional and meaningful skills. But then also when like after courses or behavioral escalations are happening, how to safely de escalate as well. In addition to

12:24this, the model also considers mediation as one of a such aspects. Now, mediation is basically like people who would be responsible for implementing your plan. How do you go about like training them to implement the plan, but then also identify factors that would basically that would be that would hinder the implementation as well. So you would analyze and then walk towards making that implementation cosmoly. And in turn, like again, it also looks at some outcomes, which again is measured in terms of this looking at teaching and improving the person's quality of life, reducing the rate and the severity of the behaviors of concern, concerns, it could be improving social validity and it has legs, yeah, some.

13:27Some some some I just need a measure, but like it does have like some breakdown. Okay, now after the comprehensive functional assessment, the next step is introducing a behavior support plan, which in itself has a proactive and reactive components to it. Now under proactive components, firstly, you would go about making the changes to the environment. This is where you would look at what interpersonal the physical environment and the programmatic environment may require some modifications to best suit the needs of the person. You may want to also look at preventive strategies and teaching meaningful skills, function based skills to the person and reactive component would focus on if precursors or the targeted behaviors were to occur, how to safely de escalate them.

14:30The plan in itself, like the support plan would consider the mediation aspect, which would basically include training the supports who are likely to implement the plan, but then also identifying what barriers or challenges can look like and how to meaningfully address them. Now, when we talk about outcomes, the framework in itself will look at improving the person's quality of life, it will look at what the social validity of our plan is looking like. So the acceptability part of it, what the durability of the effects are, how are we able to generalize them? Are there any side effects? And if there is a again, a reduction, a rapid control over the rate and severity of the targeted behaviors? So it's like it has like multiple outcomes that like, you would be working towards was was mebs your first

15:32introduction to the construction approach? Yes, yes, yes. So previously, at least, I would say previously, I was more oriented towards implementing the work that's been done by Dr. Hanley. And then it's it's basically like there was a switch in organizations and that organization, I mean, like this is my current organization that I'm talking about, the center of positive behavior support, this is the place where I was introduced to the framework. It's it's basically the way it flows considering like again, I would say the place where I am at at this point in the sense that it's hard to find services, it's even hard to find practitioners. So even if like we have to train the practitioners, they may not have like the practitioners here may not have like enough, then don't have enough experience in delivering behavior support services. And having this framework for them, like as a tool, it does provide that guidance

16:34that how do I let go about conducting those assessments, delivering a behavior support plan, and then also consider the other factors that would potentially be a barrier in my implementation, which again is the mediation aspect of it. And then like looking at this barriers and attempting to resolve anything that may impact. I love it. I realized I kind of put you on the spot. I've I only reason I asked so many questions about it is I only read I was only recently sort of reintroduced to mebs. I had heard about it years and years and years and years ago. To be honest, I kind of avoided their their model simply because the the training was so expensive to learn about it. Yep. They had some really expensive courses down in California. They had you know, in hindsight, I kind of wish I took them because as I learn read, learn about it now, it's it really, I think it's it's it's it's a lovely model. And

17:36and like I said, it incorporates that constructional aspect. I love that whole mediation piece. I love the I love the idea of sort of of episode severity and episodics and sort of the idea that we made we don't necessarily have to get rid of the thing altogether. We just need to make it a little less dangerous potentially, you know, and so you know, can we make behaviors in it can we you know, because I think about the classic example of I know I knew a young man who used to tap his head against the wall like this ever so lightly, you know, he's still technically banging his head 800 times a day. Yeah, but he's not having any injuries and he's just started doing it to communicate and it works for him, you know, I think some of those pieces really, you know, I think I think PBS could learn a lot from meps. Yeah, yeah, and it's it's interesting that you're talking about episodic severity because that's that's one of the things like as soon as we start our services, one of the main things that we

18:41work towards is reducing that and which again, to reduce episodic severity, we would be using a lot of like reactive strategies to immediately deescalate and which would mean that you may want to deliver function reinforcers that are maintaining that behavior at like a precursor level, so that it's not escalating to a point where in the person is getting injured or like is requiring hospitalization. So it's it's mainly like focusing on meeting the needs of the person as soon as possible, early on in the chain of behavioral escalation. And I also then see some alignment there with some of the PFA SBT work. Yeah. And do you find that that you're able to sort of bring both of those frameworks into your work? Yes, I mean, the fact that I was implementing PFA SBT a lot of

19:43because since my work was also more of providing consultative services, so a lot of universal protocols were also was something that I was implementing previously and coming to this new organization implementing a completely new framework, it had like some overlap there, but like the Mebs framework was much more, I would say to what I was what I was introduced from skill-based treatment. PFA. Yeah, really cool. Tell me about how working in India kind of shaped your lens before moving into Australia. So the experience that I had in India was mainly working in schools. One thing I did see was there was I mean, as compared to Australia, like here, there's more awareness, acceptance, inclusive support for people with disabilities, as compared to what I was seeing back there. And I

20:44mean, it has gotten better over the years, but then that was a little like different. And also like, even when I was working in the specialist school setting, or even like for families who were accessing services, like there's no insurance system that's in place in India to support services for people with disabilities to access services. So most families would be out of pocket to privately cover for services. And again, like if someone with like again, I would say like from a lower socio-economic background, they probably may have difficulty accessing services. So a lot of barriers as compared to how people can access supports out here. Tell me about your PhD, why would you decide to do a PhD first off? And then what's

21:48what's sort of the focus of your work? Yeah. So I started with my PhD. It's about three years ago. I was I was wanting to learn more. I was interested in research specifically, like in terms of how do you go about conducting an ethical scientific investigation. And in this process, how do you effectively disseminate information? Because there were a few projects I would say that I was working on. But then again, I was more interested in how do I go about conducting research? More formally. And I mean, like during this time, within my program, I have completed a thesis. I am in the process of completing an independent research study at this point. And

22:51then also working towards my dissertation proposal. Is the the paper on compassion based functional assessment of your skills? Is that part of was that your master thesis? Is that part of this project? This? Yeah. Dr. Program? Yeah. The paper got published with the behavior analysis and practice. So it basically like again, the study focused on evaluating the effects of remote training package on teaching practitioners functional assessment interviews in which we basically used a concurrent multiple baseline design across skills. The skills that were identified was firstly to teach practitioners functional assessment into viewing skills teaching cultural responsiveness skills and compassionate care skills. So these were the three skills that we had identified and we taught them sequentially. And the

23:54practitioners, basically the participants who were selected for this study were again more new to the field. So having an experience of I think, yeah, having an experience of one to three years with again limited experience in conducting functional assessment interviews. And so in terms of the functional assessment interview itself, was it a particular sort of templated questionnaire or so? How did you sort of choose the questions? So the questions were selected from so again, mebs, comprehensive function assessment. So basically the template that's been provided from LaVigna and Willis to conduct comprehensive function assessment. And I also looked into Handleys open ended interview. And so it's basically looking at what was there in both of these interview questionnaires. And then I'm basically merged and had

24:57about like nine to 14 questions that were prepared for the functional assessment interview. And then in terms of kind of making, making that functional assessment culturally responsive and compassion focused, is that was that additional questions or more about how the questions were asked and how and sort of listener behavior and responding behavior and that sort of thing? Yep, yep. So functional assessment in interview like interviewing questions was separate. Cultural responsiveness skills included its separate subskills and then compassionate care had its own subskills. So an example for cultural responsiveness skills would include that the practitioner is exploring for interpretation services from the caregiver. And if again, the

25:59caregiver feels like that, yes, arranging for an interpreter would be helpful for the assessment interview. Then the practitioner doesn't showering that they have one available for the interview. Another example would be that the practitioner is covering or asking about demographic information about routines, about roles and responsibilities of different family members within the home setting that they are refraining from using very like a technical refraining from using technical chargains within the interview, but then also identifying if the parent is wanting to learn about these terms then potentially using the term, but then also providing a simple explanation during their conversations. I mean, these are some examples of what culturally responsive skills were identified within like while you're conducting functional assessment interviews and compassionate care skills included like for instance, when your caregiver is like again, they're talking, having

27:04that discussion, the practitioner is engaging in active listening behaviors in the sense they're nodding. They are using back channeling responses. They are not interrupting the other person delivering empathy-based statements, asking for feedback. And if they're being corrected, then they are reflecting on the feedback that's been provided and checking in to make sure that what they are understanding is the same as what the caregiver is saying. Like, yeah, so like with this study in itself, like because each of these three skills were taught separately. So the sequence was that we covered functional assessment interviews and it had 14 skill components. The next cultural responsiveness skills were covered and it had nine skill components within them that the practitioner had to follow. And cultural responsiveness, compassionate care skills had about six skills. It's great. It's a great study. Can you tell me about me?

28:07It's so important. Like, I really want to dig into this some more because I feel like this could really change the way I train my folks. How much time did it take to the actual training? Yeah. So within, it's an interesting question. So within the study, like for each of the participants, I think the training training time or like the training time to just complete the study was pretty much it ranged between nine to 10 hours. So from the baseline till this, that's the completion. Yeah. Yeah. It's it's mainly because as you're conducting functional assessment interviews and you're covering all your questions, it took us some time. So about like 25 to 30 minutes to complete one functional assessment interview. In reality, I can understand it can go longer because the fact that we work conducting role plays in a contrived context. Right. Yeah. Really, it didn't take

29:10practitioners that long. It's not the reality of the situation. Yeah. Yeah. Yeah. People. Yeah. Go ahead. Go ahead. Yeah. I mean, like, yeah, so it's just that the training itself on like each of the subskills took about an hour, but then when we actually started implementing it and then to ensure that the practitioners were reaching their mastery, it took us a couple of sessions, trials to like get that accuracy in place. In addition to this, we also like assist maintenance of the skills, which again, the maintenance probes were conducted at one to two weeks after the completion of the intervention, but then also after three months. Is this is this the the first study you've ever published? Yes. Yes. What a what a cool first study to publish. I mean, it's I just think this is so awesome. Can you? We're not going to go through the study

30:11page by page today. I mean, folks can read it. We'll send links and whatnot. It's it's it's really cool. Capacity care seems to be really important to you and it seems to be like a central theme in a lot of what you do. Tell me more about what compassionate care looks like in practice. Yep. In my question, in practice, it would I mean, like if I would start by first defining and explaining what compassionate care really means, it is basically it can be explained as acting unpleasant or it could be pleasant contingencies. So to explain compassionate care, it includes not includes. So to simply explain compassionate care means that you tap unpleasant or pleasant contingencies in a way that you engage in a what behaviors by acknowledging those contingencies. And simple examples in practice can look like engaging in active listening behaviors, which again,

31:20that's something that you're doing right now, nodding your head, not interrupting me, right giving me those back channel responses by saying okay, make saying, mirroring emotions as the other person is providing you information. It also includes exploring the caregivers or like again, who so ever you're interviewing or having a conversation with exploring their interests, preferences and priorities, but then also reflecting on their interests preferences or priorities if something some information has been provided in the past in conversations, you may want to like you may include using strength based reflections wherein you may want to acknowledge the abilities or the efforts of the caregiver or the client summarizing information. So mainly to ensure that you're getting the information right, you're not

32:22truly assuming what the caregiver is saying in the sense that if the caregivers are describing what the course of behavior may look like, you may want to summarize it just to ensure that you're getting it right and not assuming that this is what it is or even the goals for example for services always like checking in that the information that they've provided is that what it is and where and we will continuously ask for feedback and if corrected we will reflect on okay, this is what has been communicated. We may also want to use empathy based state pens. So for instance, if the caregiver has communicated they can't believe their house or can't go to the community due to their child's behaviors. We may want to reflect on the fact that it is a rough for the family that the behavior is impacting them in a certain way wherein we may want to connect the emotion that

33:29they may be feeling but then also connect it with the context and another I think the last another I would say compassionate care skill would include partnering with their caregivers or with their clients in the sense that we may want to use V-based statements in the sense that if I am coming into your house I am not going to be the only one implementing or delivering services. We both will work together in implementing a certain goal. So a lot of this sounds like motivational interviewing. Something similar. Yeah and and this seem these skills seem to be really important and yet I don't know that they're taught a lot in our in our schooling. Did you have an opportunity to learn about this in your education or is this thing more more

34:30what you've kind of more you've just found in practice? I would say it wasn't it wasn't really taught in my school and even the research has identified this and has spoken about this that it's not so even compassionate care skills because I'm just getting both together at this point but then for compassionate care skills it's something that's not really has been taught as much and and even like when I'm training my practitioners as well when they are presented with emotionally charged situations or when like the parents are presenting or reporting of overwhelming situations or contexts to them they do not know how to respond a lot of the times they will report feeling uncomfortable unprepared and may not know what to do in those situations and that's where again like

35:36I think the training part of it is missing a lot of it is like make them across like oh we should be doing these skills but then again like it's just like not really explicitly taught like how and could be using these skills. You talk about functional assessment interviews as being a first point of contact. It kind of first interaction. Tell me about why those early conversations are so important. I mean firstly in your first point of contact especially when you're conducting a functional assessment interview you are getting some information that will be a next step towards conducting functional analyses or developing a function based intervention. In this point of contact having those skills was to ask the right question asking the right questions where and we are

36:36really tapping into what the environment and the context looks like is really important. But then also in these early conversations how we ask these questions also matter as it would determine whether the caregiver or even the client would want to continue the service with us or how they would perceive our services that would like have an impact and at this stage we also want to be creating a space wherein if they are feeling comfortable and hot they're more likely to provide us the information that we need to conduct the assessments for the assessments or intervention development. And in these cases I think the experience that the caregivers or the clients may have had really matters because I mean this is something that's been identified in the research as well

37:39that in these early conversations we may also want to acknowledge that our caregivers may firstly like have had discussed the same problem again and again probably with multiple service providers. They may be experiencing burnout. Also the caregivers from diverse backgrounds they may have experienced some form of cystic, cyst issues or barriers in terms of accessing services or having linguistic needs or may just generally find it stressful to discuss sensitive information that may impact them or the individual itself impacting the quality of life in some way. So in these in this like the first point of contact it's really important the way the practitioners are asking questions. The way they are firstly that they're asking the right questions but then also the way they ask questions should help alleviate some of the form of suffering that the caregiver may have.

38:47Can you give an example of what that might look like in practice? I mean an example could look like for instance as the caregiver is providing information about what the whole course of behavior may look like or what the triggers may look like in terms of when we are conducting functional assessment interviews they may want to firstly instead of like moving down through the checklist in terms of the these are the questions that I have to ask acknowledge what is happening in this context that it is tough for the stakeholder. We may want to reflect on this information if the information is being provided we may want to summarize mainly to ensure that we are also understanding it correctly in terms of what the behaviors are looking like what are the triggers what are the goals that they want us to work on. Yeah so it's really about not asking questions getting answers and then moving to the next question

39:51getting an answer. Yeah. The next question getting an answer. Yeah. This paper was talks about teaching practitioners in Australia. Culturally responsive practice. Can you tell me a bit about the Australian context and how PBS shapes the way services are delivered there. So when talking about the primary model of practice like within Australia, TBS is the primary model here. However at this point we do not have like any formal professional regulatory body that is overseeing behavior support services. One thing like there was also a study conducted by Kellyanne Colleges in 2024 that basically reported that the majority of the practitioners who are into service delivery at that point in time. So back

40:54in 2024 when the study was published, the majority of the practitioners only had about one year of experience in the lifting behavior support services and this survey was conducted across four around like 400 participants basically participated in this survey. So with one year of experience and the majority of the services that are being were being delivered were mainly concentrated within the metropolitan areas within the Australia which basically like the study in itself like highlighted that there is a need for training and supervision in teaching the skills like the technical skills to the practitioners but then also it highlighted the need or like even the concerns in accessing quality behavioral support within the regional rural remote regions of Australia and like even if I talk about Australia it's it's a multi cultural country wherein like

41:59the cultural and linguistic diversity is like an integral part of the community. Now as per the census conducted like the latest census, the majority of the population like it has migrants and then over 300 languages are spoken here. So it's a pretty diverse country and in addition to it like when talking about implementation and delivery of behavior support services, behavior analytic services, the Pishnas again are not like do not have like a lot of experience and specifically talking about like at least the region that I am in it's hard to find qualified practitioners with experience. So even like the research that I'm conducting like the one that was conducted for the thesis as well, it aimed at training skills, basically acquiring skills, teaching skills to

43:02practitioners with limited to no experience in delivering behavior support services but then also they had limited experience in conducting functional assessment interviews. So. And when you think about culturally responsive practice, what does that look like in a real conversation with a caregiver? I mean before I would say going into a conversation with a caregiver, so going into delivering any form of service like during practitioner allocation I would say we would want to explore with the caregiver, with the comfort in this like explore we may want to explore with the caregiver in terms of the comfort if they would prefer a male or a female practitioner, if they have any preference for cultural backgrounds or if there's a need for interpretation services or like how comfortable they feel. Otherwise in practice apart from

44:04arranging for interpretation services, we may want to collect demographic information. We may want to collect information on daily routines and once we've collected this information, we may want to use it in developing and implementing our behavior plans when we are training our stakeholders or having in any form of like the conversation that we're having to train from using technical jargons, even in our report work, emails as we are explaining about our services or having some form of conversation, not using a lot of technical language, asking clarifying information in the sense that again we do not want to come from a place wherein we make assumptions about what goal would be acceptable for this participant or this is what we should be targeting unless and until there's some risk of harm and ethically we may need to address the skill but then we may want to

45:06be asking what they want us to work on and then also mainly assessing social validity in terms of the goals that we want to work on or the procedures that we are implementing mainly checking in mainly conducting multiple check-ins to assess how services are going instead of conducting a one-time check-in. So like even if you see in our research studies, sometimes we are seeing that like only on the social validity may be conducted towards the end once the study is completed but then we may want to conduct these check-ins in multiple locations at multiple locations. So even within service delivery we may want to assess social acceptability like at multiple checkpoints to see how services are going. Are there making an impact? Are there improving the person's quality of life? Is that just asking a couple of questions? Is that a...

46:08I mean it could be it could be in when for instance you are conducting an interview for instance you have identified a certain goals you may want to check in like okay how are you feeling about it? As you start delivering services you may want to have like some periodic check-ins wherein you may ask certain questions to your caregivers to see how things are going. You may do it in the form of when you're sending out an email you may want to assess okay how do you feel about okay this is what we've discussed. Are you comfortable implementing this or how are you finding the implementation of a certain procedure that you've discussed with the family? So even like in form of assessing social validity it can be that we are asking some checklist questions they can be pretty much close ended where and we may use a like-out scale but sometimes we can just ask open-ended questions as well to see what they're finding helpful versus what they're not finding helpful within our services.

47:13And what might be some things practitioners might unintentionally overlook? I would say specifically practitioners early in the careers may when they are having these conversations with their stakeholders they may tell them what to do instead of collaborating and consulting with the participant or with the caregiver on a non-going basis a lot of the conversation that they may have may come across as if okay this is what you need to do than coming up with strategies of programming together and working on it like that. Also like sometimes I would say arranging like for interpretation services may get missed out or like or even if we are checking in for interpretation services we may not explore the comfort of the

48:19caregiver in terms of if they would be comfortable having like an external person there in your conversation like in your interview in your conversation and the other thing I would say that probably gets missed out is we are conducting interviews we may have like the technical skills in terms of to get that information from the stakeholders but sometimes I think observations going out in the field seeing what the persons environment is looking like is it's really important because that will help the practitioner identify the physical interpersonal aspects of the environment that are supporting on maybe not supporting the needs of the person and the other thing I would say the last thing I would add on to it would be assuming that a certain goal or a target would be suitable a participant. That's a common one I think. Can we put you on the spot? So you talked a lot

49:26about there being a large migrant population in Australia and so a lot of different languages so on and some different strategies around supporting these folks. Australia also has a diverse and vibrant indigenous community. Look at ahead what you'll be your deep and your PhD hopefully done in the not too distant future. What do you hope to explore next in your work? Yeah so at this point I have recently completed my independent research project that mainly focused on generalizing compassionate care skills across multiple service delivery contacts. Cool. So far like I have been only talking about functional assessment interviews. In this study

50:34I basically looked at using compassionate care skills across three service delivery contacts. So the contexts were functional assessment interviews using compassionate care skills during caregiver training and email writing. So it's mainly generalizing the use again with practitioners who are new to the field early on in their careers. Now in the study we used non concurrent multiple baseline design across three participants and what we did was we conducted probes with caregivers in a naturalistic setting in the service setting wherever the practitioner was delivering services and these probes across like the three contexts that I just mentioned they were conducted as and when the opportunities came up. So if they were conducting a functional assessment interview basically their supervisor was also out there in the field providing supervision

51:40to them and during this time they were also collecting data on their use of compassionate care skills and within the training process this time we basically made the implementation of compassionate care skills more flexible in the sense okay if the opportunity was coming up and if the use of the compassionate care skill was needed they implemented otherwise if it's not needed they don't implement. So it was more of an individualized implementation wherein they were looking at the context and not just using the skills as form of a checklist that I need to do this this this this by implementing and interacting with caregivers. So we have been able to complete the study it still needs to be written like needs to be like written down hasn't been published or isn't the process of like getting the background work like basically the written part

52:44done at this point all the practitioners like when we started off the study within the during the baseline phase they had like low to moderate responding across the three contexts and following the training we were able to see the responding increased and with two participants we were able to complete maintenance checks and the skills were maintained for them and all participants reported high satisfaction with the training procedure and also the outcomes. What's your hope for the so that again like is a process that I'm working on at this point so now in context to cultural responsiveness and compassionate care skills there is our recommendations on how practitioners need to self reflect on the implementation of their skills. So self reflection is a big thing that has been recommended and for my dissertation I am looking at a way to use a self monitoring tool

53:48to use culturally responsive and compassionate care skills across service delivery context. So I'm still yet to propose like defend my proposal at this point but then like the study would focus on examining the effects of a self monitoring tool to acquire culturally responsive and compassionate care skills but then also generalize them across different service delivery context. So it will like basically now focus on not just functional assessment interviews again it will be across multiple service context. I'm also like hoping to break down compassionate care skills further in the sense when we are talking about compassionate care we are looking at some vocal and non-vocal typographies so breaking that down further but then also looking at ways that how do we make the use of compassionate care skills more culturally responsive as well and this is where like we may want to avoid the blanket use have some flexible implementation based on like how opportunities

54:52are coming up and we are using them and even like in terms of rating measuring those like the implementation part of it having like some form of a rating skill instead of a yes or a no response. For practitioners listening who maybe want to do better in this area where would be a good place for them to start? I mean I would say start by approaching every interaction with humility take time to learn about the individual the caregivers values experiences the preferences the cultural context as you go into conducting your assessments and developing interventions and I would say like cultural responsiveness and compassionate care skills these these are not skills that you can just master by knowing what the sub-skills are looking like. It does these skills they do require a lot of like ongoing self-reflection and ongoing

55:52learning and professional development to best support the people that we are supporting. What might be one takeaway from your work you wish more people in the field understood? It's a tricky interesting question I would say the technical skills are important but then even like your best evidence based interventions are less likely to be successful if your participants and your caregivers are not feeling hard respected or understood. You're doing some really cool work in compassion cultural responsiveness. Again I gotta say this is just a really cool first paper so I'm really excited to see kind of what you generate in the future and yeah it's been it's been fascinating learning about your work thanks for coming on the podcast. Thank you for having me. Thank you for listening to this episode of BehaviorsD. One of my biggest takeaways from this conversation is that effective behavior support requires more than practical competence. As Preedy reminds us even the best evidence based interventions

56:57can struggle when caregivers and participants do not feel heard respected or understood. I really appreciate it pre-desharing both your research and practical experience supporting practitioners to develop compassionate and culturally responsive skills. Her work is a reminder that how we engage with people can be just as important as the intervention we deserve. I've also found myself learning a tremendous amount from the Australian behavior analytic and positive behavior support community over the last little while. There is some incredibly thoughtful work happening around cultural responsiveness, construction approaches, quality of life and persons that are service-deleted. If today's conversation resonated with you, I'd encourage you to explore a few other Behaviors speak episodes from the region. If you only listen to one other episode make it episode 148. Behaviour analysis in the first nation communities of Australia with the incredible depth for Nando. You may also enjoy the evolution of Behaviour analysis in Australia with each ailing worth beyond behavior reduction reclaiming the construction approach in PBS with Oliver Roshki and John Wooderson and episode 222, applications of the construction approach with Dr. Madura Deshpande. You'll hear many of the

58:00same theme explored throughout those conversations including cultural humility, constructional approaches, meaningful skill building and improving quality of life. As always you'll find links to Preedy's work and all of the resources discussed in today's conversation in the show notes including links to these other episodes. If you enjoyed this episode please subscribe, leave a review and share it with a colleague. Thanks for listening and we'll see you next time on Behaviour's Speak.