Burning Bridges

There’s a kid on the floor, crying, when I arrive.  The therapist, or I should say, “interventionist” – they recently changed our titles back because we aren’t credentialed enough to be called therapists—stands positioned to prevent escape, while addressing a very distressed and concerned woman, who I presume is the kid’s mom. 

            “We just want to ignore this right now, so the best thing to do is gonna be for you to just say, ‘Bye Leo, see you after group', and walk out, okay?  We don’t want to reinforce this type of behavior.”   

All these behavior agencies are the same.  They plaster a bunch of happy faces on their websites, and they hang happy pictures all over their walls, but the only people that are happy are the ones sitting in some office collecting checks.  They either don’t see that EBA isn’t as effective as it’s cracked up to be, or they don’t really sweat it because they profit from ongoing intervention.  Everyone else, though, is screaming for a way out. The kids, the parents, the interventionists who actually spend time with kids with autism, the clinicians who are buried in paper, even the receptionist and intake specialists are miserable.    

The mom does as she is told, and blows a kiss as she backs out the front door.  This upsets the boy even more, and not only does he start screaming now, he’s hitting the interventionist’s leg with a closed fist with one hand and trying to scratch her toes with the other hand.  She moves her leg out of his reach and, following protocol, she says, “Here’s your choice, Leo.  You can walk, or I will help you walk.”   

We are taught to use a neutral tone, but that’s easier said than done.  People aren’t pigeons.  They get frustrated, and when you’ve been around as long as I have, you learn to spot it a mile away.  I just feel bad for the kid. He has no choice in the matter.  Whether he likes it or not, he has to go “play” with someone who just told his mom to ignore his feelings.  I’m sure that’s not going to fuck the kid up.  Give it a few years, and I bet he’ll be busting down doors at the prospect of meeting new people and making friends.   

Almost as if she’s proud of her solution, she says it again.  

            "You can walk, Leo, or I will help you walk.  Your choice."

Now all of us in the room are watching and waiting to see her clinical response.  Will she follow through?  The boy begins to deescalate, and the intensity level of his tantrum drops a few marks, but he’s still protesting. 

            “No pay,” he whines.  “No pay.”  

            “Leo, your choice.  You can walk, or I will help you walk," she repeats, now with a tinge of annoyance. 

            “No pay...” 

            “Okay, Leo.  I will help you.” 

The interventionists places her hands under each of his armpits and lifts the kid to his feet, but he refuses to stand and leaves his legs limp.  Undeterred, the interventionist walks with him, dragging his feet down a long hallway.  The volume of his protests grow louder with each step.   

            “No pay...  No pay.” 

She ignores it and follows through as neutrally as possible.   

I walk to the front desk, and the receptionist, busy and unfulfilled, looks up at me just long enough to say, “Hello.” 

            “Hey.  Wow.  That was pretty intense.” 

            “Yeah, he hates coming to group.” 

            “Yeah, how dare he say 'no' to group.  Can’t let that happen.  Did nobody tell him he has autism?” 

I smile to let her know I'm being playful, but she knows I’m a nuisance. 

            “Can I help you?” 

            “Yes, my name’s Ed.  I’m here for an interview with Dr. Stinson.”   

She hands me one of a dozen clipboards lined neatly on her desk, prepped with applications and ballpoint pens.  

            “Okay, I will let her know you’re here.  Go ahead and have a seat, and fill this out.”   

The top of the application specifically instructs not to write “see resume” in any of the blanks, but I do it anyway because I’m tired of repeating myself.  It’s my third application this week.  I've been considering a different career path, but the wifey gave me an ultimatum last week: "get back to work, or get out;" so, this is not the ideal time for an identity crisis.  Not that she should shoulder any of the blame for my poor decision-making prowess.  In more ways than one, I haven't exactly been pulling my weight, and she has every right to demand more of her partner.  Nonetheless, I'm not here to land a job.  Not yet, anyway.  There's a good chance the wifey is upset at how comfortable I am with under-achieving, but if it's anything like our last blowout, taking interviews and actively looking for work should buy me a couple more weeks of late mornings and day-tripping.  The only lines I fill in are my name, references, and pay rate – which I inflate by three dollars.     
 

Dr. Stinson eventually steps out to greet me.  She grabs my application from the receptionist and extends her hand.  One doesn’t need a formal evaluation to assess that she herself would benefit from some EBA.  She’s at least 60 pounds overweight, and her smile lacks any affect or inspiration.  Of course, her behavior could have something to do with some personal tragedy, or a thyroid condition, but EBA doesn’t concern itself with variables unavailable to the unaided eye.  Our focus is the observable relationship behavior has with the environment.  I jump up and shake her hand, oozing with carefree confidence.       

There's a remarkable difference I've noticed with the interview process when you don’t give two shits about landing the job.  It's liberating, really.  People observe it on your face, they hear it in your tone, and they read it through your body language, and they turn green with envy.  They stare at you with dreamy eyes, wondering what it must be like to be the pilot of your own fate.

A manila folder sits on the glass table next to what looks like a series of interview questions.  There’s nothing thoughtful about it.  A good majority of the people I work with live their lives this way.  Lost without a script, or a diagnostic manual.  It’s all black or white for them.  1’s or 0’s.  Nouns and verbs.  Either, or.  We know you have autism because you engage in behaviors listed in the manual, and you engage in behaviors listed in the manual because you have autism.  Science says to follow this protocol.  Thank you, the BCBM.  Religious, but only about their own beliefs.  

Dr. Stinson and I take opposite sides of the table, and as she opens the folder to pull out my resume, I begin the interview.   

            “So, how long have you been with PACES?” 

            “This is my third year.” 

            “Oh, so you were here during the transition from DDS to insurance?  I bet that was a mess.”   

            “It was a bit of a hiccup, but in what way are you referring?”  

            “Well, the agency I was with had a lot of turnover during that time.  They cut incentives for evening sessions, or for working with severe behaviors, a lot of people lost health benefits.  Some of the clinical staff were let go, too.  It was pretty chaotic.”   

She looked down at my resume.   

            “Transitions can certainly be chaotic.  I see you were with Bridges Behavioral.  I also noticed you have a son of your own on the autism spectrum.  Is that what got you into this field?”   

I added the whole bit about having a child with autism after some parting advice from one of my supervisors at Bridges.  She asked me what my plan was, and I told her I wasn’t sure I could do the direct work anymore, not with all the cuts anyway, and she told me to “fake it ‘til you make it.”  I’ve never thought so much about what that saying means as I did that night, and before I could fall asleep, I’d decided I either needed to finish my Master’s and sit for the exam and fake my commitment to the science, or I could fake being a parent and work my way into a more consistent and EBA-free position as a parent liaison, like Rob Jackson, who held the position at Bridges.  He was always coming and going as he pleased, and never had anyone telling him to restrain a kid.  Adding a fictional comment to my relevant skills regarding my unique commitment to families as a parent-practitioner was one of the easiest decisions I've ever made, really.   

            “Yeah.  I was sort of charting one course, and then my boy took our family an entirely different direction.  He’s nonvocal, so initially, I was at the library researching FCT, trying to figure out how I was going to help him communicate.  Then the rest is, as they say, ‘history’.  I begged IST, my first agency, to bring me on and train me, and they were kind enough to give me my start.” 

I was just pulling stories from different families and kiddos I'd worked with over the years.

            “I did see that.  I have several friends at IST.  They are a great company.  That brings me to another question I had for you.  Why did you feel the need to leave those agencies?” 

            “Well, with IST, it was because my son was accepted to a special school in San Diego, and we decided to go all in and enroll him in the program.  We relocated, but soon after, my wife’s mother was diagnosed with cancer, so we moved back home.  That’s when I applied with Bridges.” 

            “That’s unfortunate.  I hope she beat it,” she replied, almost as if she were reading a cue card. 

            “Yes, actually, it wasn’t too serious at all.  It was skin cancer, and it was early enough they were able to just remove it.  And with Bridges, well, if I can be candid here, that had a lot to do with all the cuts.  I guess, before we go any further, I should ask you what the hourly rate is for this position.”   

            “All of our interventionists start at 16 dollars an hour.” 

            “Wow.  That’s lower than I made when I started 4 years ago.  Does my experience not count for anything?”   

            “If you pass our competencies, you can earn a promotion to a senior interventionists, which would be a bump up, but unfortunately, that is our rate for the position we are hiring for at this time.” 

She looked at me, waiting for me to respond to the offer. To ensure I didn't get a formal offer, I wanted to make my answer as clear as possible.

            “That seems a little unethical.  Rather than pay a couple dollars extra for an interventionist with experience, you’ll hire someone with no training or experience, thanks to the lax insurance guidelines, because you can pay them less.  That’s not evidence-based, that’s reimbursement-based.” 

            “You are mistaken.  We pay a competitive rate, and it’s one that is set by the insurance companies.”   

            “That’s a crock of shit.” 

            “Excuse me.  This interview is done.  Have a good afternoon, and thank you for your time.” 

            “No, I drove all the way out here and filled out your little application for a laughable offer; you can let me finish saying what I want to say.  You don’t need to shut down just because I’m questioning your business practices.  I know the rates just about every provider pays, and even at the bottom of the scale, it’s more than double that for direct-level services, and that doesn’t include the profit you make on parent-training hours and BCBM hours.  So, yeah, that is a crock of shit.  More importantly, though, is that kids like mine will fail to make meaningful progress because you want to cut your fucking corners for a few extra bucks and hire people who don't know what they're doing.  You say your intervention is key, well, start acting like it.” 

It hasn’t always been like this, but I think I could get used to it.  

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