The Importance of Pairing Time

I think one of the biggest mistakes that can happen in behavioral intervention and community support services is a lack of building rapport or “pairing” with a new client. While I appreciate a provider who wants to start driving change right away, pairing is an important success factor in service provision. Many studies (Behavioral Analysis in Practice 2017, Journal of Early Intensive Behavioral Intervention 2007, Behavioral Interventions 2015, etc.) have recognized the importance of building rapport prior to starting intervention. Several have also found an importance in client pairing at the beginning of each session.

The term “pairing” comes from the act of connecting ourselves with reinforcing items or activities. According to HowToABA.com, “Pairing is the first step when you begin working with a new client… Your goal should be that the client wants to see you - your presence is not just tolerated, but actually enjoyed!”

AppliedABC.com explains “if an unfamiliar adult walks into your session without taking the time to pair with the child and then begins making demands, it’s likely that the child may engage in problem behaviors or avoid the adult entirely to show their discomfort.”

I witnessed this issue firsthand with my youngest child. He was starting behavioral intervention with a provider he had never met before. The provider had a lot of experience and strengths in plan development, setting boundaries and even engagement, however, we both were of the mindset that she should jump right into intervention. This backfired and my son became very defiant and disrespectful toward her.

The second time that we hired a provider, we decided that the first week or so should be exclusively dedicated to pairing. My son bonded with the provider before expectations were introduced and new skills were being taught. This built a foundational relationship based on trust and formed an impression within him that intervention was “fun”.

I asked a few intervention providers to share their experiences and perspectives about pairing. Here’s what they had to say:

“Pairing is the foundation of behavioral intervention - It is a continuous form of building trust and advocacy for our learners.”

— Jamie (Local BI Provider)

“Pairing is about building and maintaining a rapport between two people. It helps (future) boundary setting and demand requests.””

— Michelle (Local BI Provider)

Additionally, pairing provides opportunities to cultivate and explore curiosity, which facilitates relationship and learning.

“Everyone has experienced less-than-fulfilling interactions where someone just talks at you versus with you... It is the opposite that supports our feelings of kinship with others...

When someone is curious about you and you are curious about them, you gain that back-and-forth feedback system that has a synchrony, feels good, and is energizing...”

— Barb Avila, "Seeing Autism"

If you’re struggling to come up with ideas for building client rapport, here are a few suggestions:

• Observe them and see what they enjoy

• Participate in a preferred activity with them

• Repeat back what they said, so they know that you heard and understood them

• Talk about a subject they enjoy

• Have fun (play a game, be silly, use humor)

• Show empathy and compassion

I would love to hear how pairing has helped in YOUR intervention sessions or work with clients. Please share your best practices in the comments below.

How to Write a Compelling Job Ad

You want to find the right person to work with you or your loved one, but where to begin? As an experienced Recruiter who has acquired top talent for everyone from small businesses to Fortune 100 companies, I have some tried and true suggestions that may help.

The following steps are similar to the process I walk business clients through (with a few tweaks to make them relevant for caregiving, BI and CSW positions).

Define the Job

Today’s candidates have lots of options, short attention spans and little time to spend reading postings. If they don’t understand or resonate with the job duties, it’s unlikely they will take the time to apply (or call you back if they are mass applying).

It’s essential that you have a clear understanding of the tasks that will be involved in your position. This establishes expectations for your new employee and can be important in certain employment situations that can arise. You can find SHRM’s list of many reasons for having a formal job description in this article.

Here are a few ways to get started developing yours:

1. Review similar job postings on job boards like Indeed.com, O*Net, LinkedIn or agency websites.

2. Document your day. Write down each activity you complete when helping your family member or what your family members are doing to support you.

3. Think through how this role aligns with the family or individual’s values and goals. What is the overall mission of this position?

Now that you have a starting point, you will want to begin developing content for each section of the job description. These include:

1. Job Title - It’s best to use a common title that candidates will think to search. While “Happiness Champion” may make the job seem fun and meaningful, it won’t help applicants to find your posting online. Job search is very keyword-driven these days and the job title plays directly into your recruiting success.

2. Location - Will your employee primarily be working in your home, in the community, at a school or some combination of these?

3. Hours - Do you need help part-time or full-time? Will the person be sharing hours with another employee or do you want one person to cover all of the shifts? The more specific you can be about the schedule, the less time you will waste on the phone with candidates who are seeking something else.

4. Roles & Responsibilities - This section should describe the activities, position scope and level of responsibility that the person will assume. It’s a good idea to confirm that your position expectations align with any program rules or guidelines.

Define the Qualifications

After considering WHAT your position will entail, we now need to consider WHO will be a good fit for this type of role. What skills, experience or education does your employee need to have to be successful?

As you look at each activity, it’s a good idea to ask yourself “what skill is needed to perform this activity”. For each skill, you can ask “what experience, education or training is needed to build this skill”.

Through this exercise, you will begin to realize your job’s essential qualifications (which anyone working in the position must have) and preferred skills (those you would appreciate but aren’t required). Start listing each of these out. Keep in mind that that you may need to justify these qualifications in certain circumstances, especially if they could seem discriminatory.

Define the Pay

Next, you will need to learn what market pay is for someone with these qualifications. You can often find market rates on sites like Salary.com, Glassdoor, LinkedIn, Payscale.com, ONetOnline.org or by asking individuals who are currently employed in the field.

Additionally, you will need to understand any pay parameters associated with your program (Family-Directed, Self-Directed, CFH, etc.) I mention this because program rate caps are historically far behind market rates.

A couple compelling reasons to post the pay rate within your job ad are:

1. 10+ States (CA, CO, CT, MD, NV, NJ, NY, OH, RI, WA), as of today, require pay transparency. As job seekers get accustomed to seeing pay rates on postings, they are less likely to click on opportunities that do not include pay.

2. 22% of job seekers believe pay transparency on job postings should be the employer’s top priority About 1/3 of job hunters say they will not participate in a job interview if they don’t know what pay the employer is offering.

As you can see, you will be limiting your applicant pool, if you aren’t including pay in your job ad.

Define the Culture

57% of job seekers surveyed by HR Dive said they consider culture as important as pay. Prospective employees want to work in a physically and psychologically safe environment. While we can’t guarantee that nothing bad will happen, we can explain the measures we are taking to keep employees safe and engaged. Here are a few questions you can answer to help determine your workplace culture:

1. How do employees, the participant and the family treat one another?

2. What policies have you established?

3. How open to change are other employees, the participant and the family? Are new ideas welcomed? Implemented?

4. Do you offer any training or professional development opportunities (with other providers, observing therapy appointments, group discounts on certifications, etc.)?

5. Do you do anything to celebrate goals being achieved, work anniversaries or birthdays?

6. Why have long-term employees worked here for an extended amount of time?

7. Does the team frequently help one another (fill-in, teach a new approach that’s working well, leave notes for one another, etc.)?

8. Are there any safety protocols, equipment or tools used in the environment? What does one do if they need help?

9. What level of autonomy do employees have in their work? Can they make decisions about the schedule and/or activities for the day? Are employees allowed to accept personal phone calls, check their texts or be on their phone while working?

10. How are scheduling changes or time off requests received? Does the family encourage vacations?

Develop the Job Ad

Your job ad should consist of all the previously mentioned sections. Here is a free job ad template that you can download to get started: Job Ad Template

If you are a participant or a family (not a business), you will want to anonymize your job ad to protect your privacy and avoid scammers. In place of “company name” you might list something like “30-year old female with CP” or “parents of a 5-year old Autistic boy”. Applicants typically need to know a little bit about the situation to determine fit, but never any personally identifying information. Age and diagnosis are usually enough to help someone know if the job aligns with what they are seeking. You can add in a few special interests (Legos, working out, baking, animals, etc.) too, since this can often be an important source of alignment for providers and participants.

Additional tips for writing a great job ad include:

1. Voice - Applicants will be paying attention to the tone or “voice” used in the ad. Try to write in your natural voice to attract individuals who will feel comfortable with your organic engagement style.

2. Target Candidate Persona - Just as marketers develop personas to ensure their messages will attract their target audience, you too may want to consider the words and job aspects that will be most meaningful to your ideal candidate. Companies often find it helpful to think about what drew in their best employees from the past (what mattered to them?).

3. Differentiation - Candidates want to know why they should consider YOUR job over similar opportunities. Don’t be afraid to mention what makes your environment or role unique.

4. Simplicity & Conciseness - As I mentioned before, most job seekers don’t have a lot of time to dedicate to reading postings and applying. So, be sure your message is to-the-point and avoid fluff and big words.

Inspiration: Award-Winning Job Ads

https://resources.workable.com/stories-and-insights/best-job-ad-examples

https://www.talentlyft.com/en/blog/article/268/top-10-best-job-ad-examples

http://blog.hirerabbit.com/17-recruitment-ads-that-will-bring-a-smile-to-your-face/

Do YOU have any great job ad writing tips to share? If so, we would love to hear about them in the Comments section below!

How to Evaluate Client-Provider Fit

You have a limited number of hours to dedicate to clients each week and naturally want to fill these hours with clients who are a good fit for your skills and services. But, how does a provider go about evaluating this fit?

Here are a few key areas that we’ve found helpful to consider.

Client Needs

We all have different strengths and weaknesses. It’s important to consider yours before taking on a new client. Below are a few questions that you may want to ask yourself.

Are you qualified to treat the specific condition or challenges that this client has?

Do you speak the client’s native language? Does your staff?

Do you accept the form of payment (e.g., insurance) that the client needs to pay with?

Is there someone else, who specializes in their area of need, that might be able to help them better?

Scheduling

Many clients wait months or even years to receive services and they may be willing to accept any time slot that you have open. However, this initial flexibility may fade and you could find yourself pressured into moving clients around to accommodate their actual scheduling needs. It’s a good idea to have this conversation up-front and to consider any anticipated time off (e.g., maternity leave, surgery, extended vacation, etc.) that could inhibit the client’s progress.

Does your availability align with the client’s availability for sessions?

Is their (or your) schedule likely to change in the near future?

Do you have any planned leaves that might impact this client’s progress?

Motivation

We aren’t all motivated in the same ways, and some clients perceive motivation as manipulation, so it’s essential that you consider what engages, inspires and conveys respect for your potential new client.

Are you able to motivate this client in the manner that works best for them?

Does this client want to be motivated to perform in sessions?

How does the family feel about your methods of motivation?

Safety

You may have the opportunity to work with individuals who can become aggressive and/or destructive. It’s important to decide ahead of time what behaviors you are prepared for and what behaviors might not be a fit for your practice. In addition to considering this for yourself and your staff, you might also want to consider your current patient/client portfolio.

Do you have clients who have experienced trauma that could be triggered by an aggressive or destructive new patient?

Do you have clients who have auditory or sensory sensitivities that could become overstimulated by this new client’s behavior?

Is your current environment safe for the behaviors of this client? Will it help reduce or will it incite these behaviors?

How will you keep yourself and others safe if the client becomes aggressive and/or destructive?

Expectations

Establishing, clarifying and managing expectations is a core factor in quality intervention and therapy services. It’s a great idea to have your expectations written out and to review these ahead of a consultation or evaluation. For example:

Do you need the family’s involvement to be effective with this client?

Do you need this client to complete homework outside of sessions?

What does this client expect of you? Are you able to meet these expectations?

Will you need this client to regularly complete paperwork or schedule evaluation times outside of their sessions? Are they able to accommodate these requests?

What does the intervention/therapy timeline look like? Is this what the client anticipated?

How will financial matters be handled (if insurance doesn’t pay)?

Integrity

It would be ideal if we could assume great intent for every potential client, but the reality is that individual levels of integrity vary. If honesty and dependability are important to you, evaluating integrity is important. Here are some points to consider:

How does the client/family speak about other providers?

Does the client/family take responsibility for mistakes they’ve made in the past (or is it always someone else’s fault)?

Does this client/family welcome accountability?

How frequently has this client/family changed providers?

Has the client/family tried to shortcut or bypass your intake process?

Considering all these aspects of client-provider fit may seem like a lot of work. However, those who consistently evaluate for fit ahead of accepting a new client/patient find there is a lot less stress, risk and liability down the line.

Are there other areas of fit that you consider in your practice? Please share your insights in the comments.

Lessons Learned From Managing 10+ CSWs

While the Family Directed Services and Self-Directed Services programs in Idaho have been tremendously helpful to participants and families seeking high quality services, they have thrown many individuals into a managerial role without much training or previous experience.

I was fortunate to have multiple certifications in Human Resource Management, a decade of corporate recruiting experience and a few years of supervisory experience prior to my son starting in the FDS program. Even with this background, I had to learn some lessons the hard way. I’m sharing some of these lessons here, with the hope it will help you avoid potential pitfalls in this unique employment arrangement.

Be Selective

Your CSW will be responsible for keeping you or your loved one safe in certain situations. They will potentially have access to your home, vehicles, pets, other family members and private information. Their attention to detail, diligence or behavior in an emergency situation could make a difference in you or your loved one’s health and safety. In addition, there are predators who target vulnerable individuals. For all of these reasons and more, it’s essential that you are selective about who you hire as a CSW.

1. It’s a good idea to require a resume as part of your application process. A resume is documentation of the experience and skills the person is claiming to have. If the information they share in the interview doesn’t match up with their resume, this is an good indicator of deception.

2. It’s a good idea to interview the person more than once. If the information provided across the resume and multiple interviews aligns, it is more likely the person is being honest. This also gives you the opportunity to evaluate their candidacy in different scenarios.

   Personally, I conduct a 30-minute phone interview with qualified candidates first, then invite the finalists to come to our home and to meet us in-person. It’s always interesting to see how behaviors and answers shift or remain the same across these steps.

3. After the interview, compare how the person’s answers matched up with their actions. For example, if they claimed to be in this field because they love working with individuals with unique needs but were more interested in learning about the pay/schedule than the participant, this is likely a case of someone telling you what they think you want to hear.

4. Always conduct a background check and consider checking professional references. Every year there are countless cases of crimes against vulnerable individuals. While financial exploitation is the most common crime against vulnerable individuals, there are also regular instances of emotional abuse, physical abuse, sexual abuse, kidnapping and more. It’s critical that you check each potential CSW’s criminal history BEFORE hiring them.

A few resources/links you may find helpful in this effort:

Potential CSW Interview Questions

Idaho DHW Criminal History Unit

Checkster Online Reference Checks

10 Signs of Deception

Be Clear About Expectations

You may have certain ways you like things done, expectations about how items in yours space are handled or a unique parenting approach that you practice. Your CSW won’t know any of this unless you tell them.

I suggest starting this process at the point of posting the job. Your job ad should share any important details about your environment, necessary qualifications and how the CSW role operates (FEA involvement, support goals, etc.) You can also convey these details in the first interview.

Once you’ve selected an individual, it’s important to have an orientation process. Some families write up a document that they share with new CSWs, others talk through important items and some even develop an entire training manual to share. Whatever your method, the point is to set your new CSW up for success. This is also when you will want to go through the SSP and backup plans with a new employee.

Be Empathetic

Many CSW roles involve stressful situations, high levels of responsibility, physical demands and more. I find it important as an employer to recognize that this job is tough. I not only allow, but encourage my CSWs to vent their frustrations (when the participant isn’t around). Often times, validation is all that is needed to move forward from a troubling moment. You want your employee in a good headspace while they are engaging with your child.

While some folks won’t be impacted by an act of aggression, others will be. I let my CSWs know that I won’t ever hold it against them if they need to take a moment to regulate themselves. I am quick to step in and help if I can see they are flustered or upset.

Nearly half of employees surveyed by Udemy said they quit their last job because of the boss (not the work, pay or benefits). While you may not be able to improve the pay, provide benefits or control how the participant behaves, you CAN control how you manage your CSWs.

Be Approachable

Your employees shouldn’t fear asking for time off, making a suggestion, requesting help or sharing a concern. If you create a toxic environment, you WILL lose good employees. Consider your facial expressions, tone of voice and how realistic your expectations may or may not be. While a request for time off may bring a host of challenges for you, it’s completely normal for an employee to need to take some time off from work for appointments, parenting duties and overall wellness. Meet your CSW’s requests and ideas with kindness and a solution-focused mindset.

Be an Advocate

Department pay rates and expectations have historically not aligned well with labor market trends. Correcting these issues requires advocacy and this primarily has had to come from participants (not CSWs). Be prepared to speak to your legislators, DHW leadership and program administrators about your concerns. Participate in Department meetings and surveys. It will take all of our voices to drive change.

Be Prepared to End the Relationship

The average tenure for CSWs is around 6 to 12 months. It’s easy to burnout in this field if you aren’t maintaining good self-care, taking breaks (time off) and growing your skills. While it may be difficult to accept, your CSWs likely won’t stay with you for more than a year or two.

You can choose to be supportive of their future departure or resentful of it. I choose the former because:

1) it enables a relationship of mutual trust and respect,

2) it’s fun to help folks achieve their dreams, and

3) your reputation with past employees impacts future hiring.

Nearly all the CSWs that I’ve hired have given me at least 2 months notice before leaving because they know that I will be supportive of their plans. (It’s also because they care about our family and are awesome humans.) When it’s safe to give notice, employees are more likely to do so.

There may also be an instance where you need to terminate an employee for cause. Not everyone who enters this field should. I’ve heard stories of theft, dishonesty and even participant abuse. It’s a good idea to determine your deal breakers before hiring anyone. Once you have defined your boundaries, it’s a good idea to incorporate them into your CSW orientation process.

I hope this information is helpful as you begin or continue a CSW employment relationship. I would love to hear any tips you have to share as well.

Market Trends in Speech Therapy

Learn the emerging market trends, median salary and trend drivers for the SLP profession in these featured posts:

1. https://speechisbeautiful.com/2017/10/5-trends-future-field-speech-pathology/

2. https://www.asha.org/careers/market-trends/#:~:text=Future%20Outlook%3A%20Speech%2DLanguage%20Pathology,over%20the%2010%2Dyear%20period.

3. https://www.bls.gov/ooh/healthcare/speech-language-pathologists.htm