When a student consistently struggles to stay on task in class or sit still enough to listen to instructions, should the teacher consult an Occupational Therapist (OT) or a clinician trained in Applied Behavior Analysis (ABA)?
Increasingly, OTs and behavior analysts alike recognize the need for, and value of, closer collaboration between their disciplines.
At Pediatric Therapeutic Services (PTS), our behavioral health and OT teams are leading the way in concrete cross-disciplinary collaborations.
Recently, PTS’ Director of Clinical Services Larysa Spisic (MS, OTR/L) and PTS’ Director of Behavioral Services Loren Gentile (M.Ed, BCBA, LBS) discussed how clinicians in their fields work together to find effective solutions for students with sensory issues.
Two Disciplines Delivering One Holistic Picture of Behavior
Naturally, ABA-trained behavior therapists and pediatric occupational therapists both concern themselves with what a student does.
When faced with a student’s sensory processing challenges, the Board Certified Behavior Analyst® (BCBA®) and Board Certified Assistant Behavior Analyst® (BCaBA®) will seek to understand a given behavior by collecting observable data about its “ABCs” : its antecedent, the behavior itself, and its consequences.
OTs collect data about behaviors too, but their specialized training in the internal vestibular and proprioceptive sensory systems leads them to more readily consider unseen factors.
These two approaches complement each other. Together, they paint a fuller picture of the student’s experience than either could independently.
According to Loren, Applied Behavior Analysis practitioners are starting to acknowledge and understand the influence of internal, “private events” on behaviors, even though such events aren’t directly observable or quantifiable.
Likewise, Larysa says OTs recognize behavior analysts’ “real strength” is tracking and documenting behavioral trends. “OTs can bring about so much change,” she says, “and the behavior analysts are able to monitor what’s working and what’s not.”
Working Together to Help Students with Sensory Processing Issues
What are some specific ways an OT and a behavioral analyst might work together to treat a child’s sensory processing disorder?
Sensory rooms are one treatment approach in which collaboration between applied behavior analysis and occupational therapy can improve effectiveness.
Clinicians from both disciplines might accompany a student to a sensory room. For instance, an OT could train a Registered Behavior TechnicianTM (RBT®) to understand the sensory systems, the room’s equipment, and to be able to adjust and implement different strategies.
The RBT can also help the student learn how to generalize the tasks done in the sensory room to other settings.
“When the OT leaves,” asks Loren, “what are we doing to make sure the student maintains regulation throughout the day?” Sensory room activities may seem effective, “but if nobody is willing to carry any of these strategies through the day, how do we know? It could be a lot of wasted resources.”
Larysa says having both fields represented in the sensory room can also head off inadvertent disruptions to the faithful implementation of therapy plans.
“I had a therapist recently working with a student,” Larysa recalls. “She was having him throw a ball against the wall. It was helping calm him down. But the behavior analyst said, ‘In his behavior plan, we don’t allow him to have a ball.’ If a student has a plan in place and as the OT, I come in and do other activities to help with self-regulation that conflict with what’s on the plan, that’s going to be an issue.”
Obstacles to, and Opportunities for, Closer Collaborations
Despite the fruitful relationship between occupational therapy and applied behavior analysis, Loren and Larysa agree these collaborations don’t yet happen as frequently as they should.
“Our OTs are jam-packed,” says Loren, “There’s not a whole lot of built-in time for collaboration.”
The COVID-19 pandemic further complicates collaboration. Many “hands-on” behavioral interventions can’t take place as intended during remote learning. School closures make it harder for therapists to know how many sensory and behavioral challenges stem from having been at home or from transitioning back to buildings.
On the other hand, Larysa believes OTs are communicating more with behavior analysts “because they’re a little bit more available” via Zoom. “And, when they’re part of an existing team from PTS, I think more collaboration naturally happens because we’ll do team meetings together.”
Collaborate with PTS to Address Students as Whole People
Through both difficulties and opportunities, PTS is promoting the benefits of closer cooperation between OTs and behavior analysts.
By introducing teachers to OT supports involving ABA techniques they can use to address some of students’ most common issues, our therapists help reduce special education programs’ costs by reducing referrals. “PTS is trying to drill home the importance of these early supports and collaboration,” says Loren, “and the global impact that they can have.”
But, fundamentally, such collaboration profoundly benefits students. As Larysa says, therapists across all disciplines “need to be working together to make sure we’re addressing a whole system, because a child is a whole person.”
Want to know more about how PTS uses sensory rooms to address children with sensory issues as whole people? Click here for instant access to our free eBook, Sensory Rooms and Self-Regulation: A Comprehensive Guide for Clinicians and Teachers.