WEBVTT
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Welcome, welcome to another episode of Am I for Change?
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Are there any clinical directors or owners of business listening to me right now?
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Well, today I want to talk to you guys, to the clinical directors, to the leaders, to the business owners, to all of us that do so much and have to deal with so much.
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Um, and I I laugh because I had I've I have an ABA company that I've had for 16 plus years.
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So I know the pain, uh, I know the suffering, I know the happiness that comes from it as well.
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But it is a lot.
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It is a lot that we definitely deal with that sometimes people outside don't see.
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But, anyways, I want to talk to you all today because you're sitting in the middle, your BCBA comes to you frustrated.
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That happens a lot of the times.
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Maybe the parent is demanding something that the BCBA doesn't agree with.
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Maybe the parent is questioning the treatment plan.
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Maybe the parent is just upset about communication, the BCBA is not returning their calls on time or the scheduling or the progress or the expectation.
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And your BCBA, that BCBA from your team, says, I can't keep doing this.
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This parent doesn't respect me, or I'm the clinical professional.
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They hired us because we are the experts.
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And you're thinking, I completely get it.
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I get the frustration, I've been there.
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But then you look at the other side and you're thinking, if we handle this wrong, this parent is going to walk.
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They're going to leave us.
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And obviously, as a business owner, you care about the client and everything else and the BCBA, but you don't want your client to also walk.
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That's sort of bad business.
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So you're kind of stuck there because you don't want your BCBA to feel like you threw them under the bus, but you also don't want the parent to feel like nobody's listening to me.
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And there's a part I think a lot of leaders don't talk about enough.
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You can support your BCBA without automatically siding with your BCBA.
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And you can preserve the parent relationship without throwing your BCBA under the bus.
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That's the real leadership skill.
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And honestly, that's where I think motivational interviewing has a place that we don't talk about enough.
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Because sometimes the person who needs MI isn't the parent.
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It's that leader that you're working with.
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If you're that clinical director or the owner, you know exactly what I'm talking about.
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You get the Slack messages, you get the text, you get pulled into the meeting.
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And the first thing you're hearing is your employee's version.
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And sometimes you're absolutely right.
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Sometimes the parent is being unreasonable.
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Sometimes the parent is asking the BCBA to do something clinically inappropriate and borderline unethical.
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Sometimes the parent is communicating in a way that maybe is not disrespectful right away, but it can become disrespectful.
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And you just hear the BCBA trying to tolerate and just trying to deal with that.
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And you see the frustration because, of course, you have been there.
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You've been in their shoes.
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You've been a BCBA in the past.
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And you still are a BCBA if you are one.
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Um, and it's it's a little bit of this of this rocky place where you don't just want the BCBA to just sit there and tolerate it.
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That's not what we're saying.
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But here's where leadership can get complicated because you have two relationships to protect.
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You have the relationship of your clinician and you have the relationship of the family.
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And those relationships, those relationships are not mutually exclusive.
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You don't have to choose, but you do have to lead differently with each one.
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And this is where we have to take a little bit of a step back.
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So I had a situation where there was a BCBA that came to me and she's like, Well, I don't get it.
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The parent wants a child to do homework and do tutoring.
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And I've already told her that this is not our role.
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This is not what her expectations should be.
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And everything the BCBA was saying was right.
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And she wanted me to meet with a parent.
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And then the parent, on the other hand, they were like, I love the BCBA, she's great, but why doesn't she understand?
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Like, I need my child to do well in school because I want them to have a future, because I want them to have a career.
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I know they can do it.
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So the BCBA is great.
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Why can't she help me with that?
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I don't get it.
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And they were basically on this kind of standstill, and I felt triangulated in this middle.
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And I remember thinking, my job here isn't to decide who wins.
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My job is to figure out how do we get everybody back to the same table, right?
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You're kind of like that glue or that kind of string that pulls them back.
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And this is where I want to challenge something because sometimes we think supporting our BCBA means agreeing with everything they say.
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And it doesn't.
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Supporting your BCBA might sound like, I understand why you're frustrated.
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I get it.
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I can see why that interaction felt difficult.
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I agree that we need to protect the clinical integrity of the program.
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But then you can also say, let's slow down and figure out what the parent is experiencing.
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And that's not betrayal, that's leadership.
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Because if your BCBA comes to you and says, the parent is impossible, you don't have to respond with, yeah, they're impossible.
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You can say, okay, tell me what happened.
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And then what do you think the parent is worried about?
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And then what do you think they're asking for underneath it all?
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What's really going on?
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That's what I always tell my BCBAs, let's get to the core.
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What are they really telling you without using their words?
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And now you're using MI principles with your team.
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You're helping your BCBA move from the parent is a problem to what is happening in the relationship.
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So instead of accusing, now we become curious.
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And that's a very different conversation.
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Here's another thing I've learned the minute the clinical team starts talking about the parent as the enemy, you have a problem.
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Because once the parent becomes difficult, demanding, noncompliant, unreasonable, or my least favorite, they just don't understand us.
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They don't understand ABA.
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We've already started losing that relationship.
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Now we're no longer trying to understand them and we're just trying to win.
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And parents don't need to win against us.
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They need to feel like we're listening to them.
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That doesn't mean we give them everything they ask for.
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That's an important distinction here.
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Listening is not agreeing.
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Empathy is not capitulation.
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Collaboration is not giving up your clinical judgment.
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You can say, I hear why you're asking for this, and still say, based on the clinical information we have, that's not the direction that I recommend based on my experience.
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Those two things can exist at the same time.
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It doesn't have to come to a conflict.
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Sometimes people think that when we nicely disagree with something someone says, it ends up in conflict.
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And that's not necessarily true.
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So if I'm talking to my BCBA, I might say, I want you to know that I hear you.
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I understand why you're frustrated.
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And I'm not asking you to compromise your ethics or your clinical judgment.
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Pause.
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But I also want us to understand what the parent is experiencing.
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Because if we lose the relationship, we don't get the opportunity to help the child.
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That is a conversation because sometimes clinicians here make the parents happy and they immediately think, you're asking me to compromise my clinical skills, my ethics.
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No, I'm asking you to understand the person sitting across from you.
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And sometimes that person is angry because they're scared.
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Sometimes they're demanding because they feel like they're they aren't really being heard.
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They haven't been hurt by other clinicians.
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Sometimes they're questioning everything because they've had five providers, neurologists, doctors, whatever before you.
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Sometimes they're pushing because they don't understand why progress isn't happening quickly enough.
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And sometimes they're really just being unreasonable.
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Let's be honest.
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But we don't have to decide which one it is before we listen and we ask.
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So here's a framework I want you to try.
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I call it protect the clinician, preserve the relationship.
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So first, protect the clinician.
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Make sure your BCBA knows I have your back.
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You don't have to tolerate disrespect.
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You don't have to agree to something clinically inappropriate.
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I'm going to support you through this.
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That matters because clinicians who don't feel supported eventually stop bringing problems to leadership.
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And that can be dangerous.
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But then comes step two, preserve the relationship.
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Now we turn towards the parent.
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And instead of saying something like, let me explain why the VCBA did what she did, we start with, help me understand what has been frustrating you.
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What were you hoping would happen?
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What feels like it isn't working right now?
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What would you need from our team to feel more confident moving forward?
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Now we're not defending, we are listening.
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And once the parent feels heard, you actually have a much better chance of being able to explain the clinical perspective.
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And again, don't take this the wrong way.
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I'm not saying that there's not going to be a point where the parent is just not getting it, I guess, or we've spoken with them a couple of times and it's not happening.
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Or the BCBA just doesn't want to work with the parent because I don't know, it reminds them of someone else, or they've already had it and they're to a point of frustration.
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And at that point, well, you have to step in and make these difficult decisions, and that's fine.
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But let's first make sure that we are communicating effectively.
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Now, let's talk about the business side for a second because we're clinicians.
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We're also running an organization.
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When a parent leaves, it's not just, oh well, we'll get another client.
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There's a child losing continuation of care.
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There's a family that's losing a relationship.
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There's a BCBA losing a case they've invested already in.
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There's a team that has no transition.
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And yes, there is a business impact.
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We shouldn't be ashamed to acknowledge that.
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Retention matters.
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But here's what I don't want leaders to do.
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Don't save the client at the expense of your clinician.
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Because if the message to your BCBA becomes whatever the parent wants, give it to them because we can't lose that case.
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You will eventually burn out your clinical team.
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And then you have a different retention problem.
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Your best clinicians will leave.
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So the goal isn't parent at all cost and it isn't BCBA at all cost.
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The goal is a sustainable relationship where their clinical team can practice ethically and the family feels heard, respected, and most importantly included.
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That's the sweet spot.
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So here's a question I want every clinical director to ask themselves this week.
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When a BCBA comes to you frustrated about a parent, before you decide where you're going to do, ask, what does the BCBA need from me right now?
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Do they need validation?
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Do they need coaching?
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Do they need help setting a boundary?
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Do they need you to join the conversation?
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Or do they need you to challenge their interpretation of what's happening?
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Because those are different things.
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And then ask, what does the parent need from us right now?
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Those answers might be completely different.
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And that's okay.
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Your job as a leader is to hold both.
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So if you're a clinical director, an owner or a leader managing BCBAs, I want you to remember something.
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Supporting your clinician doesn't mean taking their side.
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And listening to a parent doesn't mean taking theirs.
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Leadership is being able to say, I understand why you're upset to your BCBA.
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And then turn around and say, I understand why you're upset to the parent without making either to be the enemy.
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Because the goal isn't to decide who's right.
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The goal is to create enough trust that everyone can get back to work.
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And sometimes that means protecting your BCBA.
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Sometimes it means coaching them.
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Sometimes it means setting firm boundaries with the parent.
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And sometimes it means saying we could have handled that differently.
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And my friends, that is leadership too.
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So it's not whose side you want, is how do we make this work?
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I do a bunch of these trainings for clinical teams.
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And I actually had a conversation with a clinical team today.
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And they desperately wanted me to start tomorrow the training.
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And I was like, well, I can't tomorrow.
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But they were telling me all of the challenges that they were experiencing in this team.
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And we were able to set up a time to meet.
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And that's what I like doing.
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When people reach out to me and they want me to do these motivational interviewing trainings for their team, I first meet them on a call because I wouldn't be a good MI trainer if I wasn't doing what I'm preaching.
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And I first want to ask those questions to better understand what's going on, to better understand their clinicians, to better understand the challenges that they're experiencing.
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So I'm so glad that we were able to set up that meeting and that call because now I know exactly what their team needs.
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And if you're an owner of a company, if you're a clinical director and you want your team to get training on motivational interviewing, you want to be part of it as well, contact me.
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Let me know.
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We can set up a meeting, we can talk about it, we can see what's going on, and then we can plan ahead.
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We can customize a training that fits your budget, that fits your needs, and most of all fits your clinicians.
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So thank you all for being part of this episode today.
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I hope you found value in it.
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I'll see you next time.
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Thank you for joining me on today's episode of MI for Change.
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If you're ready to keep growing your motivational interviewing skills, I'd love to invite you to explore my MI Academy, where you'll find a full library of on-demand courses designed to help you put MI into practice with confidence.
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You can learn more at www.drmonicagilbert.com.
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Until next time, keep asking the questions that spark change.
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Welcome, welcome to another episode of Am I for Change?
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Are there any clinical directors or owners of business listening to me right now?
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Well, today I want to talk to you guys, to the clinical directors, to the leaders, to the business owners, to all of us that do so much and have to deal with so much.
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Um, and I I laugh because I had I've I have an ABA company that I've had for 16 plus years.
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So I know the pain, uh, I know the suffering, I know the happiness that comes from it as well.
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But it is a lot.
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It is a lot that we definitely deal with that sometimes people outside don't see.
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But, anyways, I want to talk to you all today because you're sitting in the middle, your BCBA comes to you frustrated.
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That happens a lot of the times.
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Maybe the parent is demanding something that the BCBA doesn't agree with.
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Maybe the parent is questioning the treatment plan.
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Maybe the parent is just upset about communication, the BCBA is not returning their calls on time or the scheduling or the progress or the expectation.
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And your BCBA, that BCBA from your team, says, I can't keep doing this.
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This parent doesn't respect me, or I'm the clinical professional.
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They hired us because we are the experts.
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And you're thinking, I completely get it.
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I get the frustration, I've been there.
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But then you look at the other side and you're thinking, if we handle this wrong, this parent is going to walk.
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They're going to leave us.
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And obviously, as a business owner, you care about the client and everything else and the BCBA, but you don't want your client to also walk.
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That's sort of bad business.
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So you're kind of stuck there because you don't want your BCBA to feel like you threw them under the bus, but you also don't want the parent to feel like nobody's listening to me.
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And there's a part I think a lot of leaders don't talk about enough.
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You can support your BCBA without automatically siding with your BCBA.
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And you can preserve the parent relationship without throwing your BCBA under the bus.
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That's the real leadership skill.
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And honestly, that's where I think motivational interviewing has a place that we don't talk about enough.
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Because sometimes the person who needs MI isn't the parent.
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It's that leader that you're working with.
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If you're that clinical director or the owner, you know exactly what I'm talking about.
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You get the Slack messages, you get the text, you get pulled into the meeting.
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And the first thing you're hearing is your employee's version.
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And sometimes you're absolutely right.
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Sometimes the parent is being unreasonable.
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Sometimes the parent is asking the BCBA to do something clinically inappropriate and borderline unethical.
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Sometimes the parent is communicating in a way that maybe is not disrespectful right away, but it can become disrespectful.
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And you just hear the BCBA trying to tolerate and just trying to deal with that.
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And you see the frustration because, of course, you have been there.
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You've been in their shoes.
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You've been a BCBA in the past.
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And you still are a BCBA if you are one.
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Um, and it's it's a little bit of this of this rocky place where you don't just want the BCBA to just sit there and tolerate it.
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That's not what we're saying.
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But here's where leadership can get complicated because you have two relationships to protect.
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You have the relationship of your clinician and you have the relationship of the family.
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And those relationships, those relationships are not mutually exclusive.
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You don't have to choose, but you do have to lead differently with each one.
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And this is where we have to take a little bit of a step back.
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So I had a situation where there was a BCBA that came to me and she's like, Well, I don't get it.
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The parent wants a child to do homework and do tutoring.
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And I've already told her that this is not our role.
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This is not what her expectations should be.
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And everything the BCBA was saying was right.
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And she wanted me to meet with a parent.
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And then the parent, on the other hand, they were like, I love the BCBA, she's great, but why doesn't she understand?
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Like, I need my child to do well in school because I want them to have a future, because I want them to have a career.
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I know they can do it.
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So the BCBA is great.
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Why can't she help me with that?
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I don't get it.
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And they were basically on this kind of standstill, and I felt triangulated in this middle.
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And I remember thinking, my job here isn't to decide who wins.
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My job is to figure out how do we get everybody back to the same table, right?
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You're kind of like that glue or that kind of string that pulls them back.
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And this is where I want to challenge something because sometimes we think supporting our BCBA means agreeing with everything they say.
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And it doesn't.
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Supporting your BCBA might sound like, I understand why you're frustrated.
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I get it.
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I can see why that interaction felt difficult.
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I agree that we need to protect the clinical integrity of the program.
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But then you can also say, let's slow down and figure out what the parent is experiencing.
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And that's not betrayal, that's leadership.
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Because if your BCBA comes to you and says, the parent is impossible, you don't have to respond with, yeah, they're impossible.
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You can say, okay, tell me what happened.
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And then what do you think the parent is worried about?
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And then what do you think they're asking for underneath it all?
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What's really going on?
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That's what I always tell my BCBAs, let's get to the core.
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What are they really telling you without using their words?
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And now you're using MI principles with your team.
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You're helping your BCBA move from the parent is a problem to what is happening in the relationship.
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So instead of accusing, now we become curious.
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And that's a very different conversation.
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Here's another thing I've learned the minute the clinical team starts talking about the parent as the enemy, you have a problem.
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Because once the parent becomes difficult, demanding, noncompliant, unreasonable, or my least favorite, they just don't understand us.
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They don't understand ABA.
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We've already started losing that relationship.
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Now we're no longer trying to understand them and we're just trying to win.
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And parents don't need to win against us.
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They need to feel like we're listening to them.
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That doesn't mean we give them everything they ask for.
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That's an important distinction here.
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Listening is not agreeing.
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Empathy is not capitulation.
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Collaboration is not giving up your clinical judgment.
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You can say, I hear why you're asking for this, and still say, based on the clinical information we have, that's not the direction that I recommend based on my experience.
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Those two things can exist at the same time.
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It doesn't have to come to a conflict.
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Sometimes people think that when we nicely disagree with something someone says, it ends up in conflict.
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And that's not necessarily true.
00:07:14.399 --> 00:07:18.959
So if I'm talking to my BCBA, I might say, I want you to know that I hear you.
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I understand why you're frustrated.
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And I'm not asking you to compromise your ethics or your clinical judgment.
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Pause.
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But I also want us to understand what the parent is experiencing.
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Because if we lose the relationship, we don't get the opportunity to help the child.
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That is a conversation because sometimes clinicians here make the parents happy and they immediately think, you're asking me to compromise my clinical skills, my ethics.
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No, I'm asking you to understand the person sitting across from you.
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And sometimes that person is angry because they're scared.
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Sometimes they're demanding because they feel like they're they aren't really being heard.
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They haven't been hurt by other clinicians.
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Sometimes they're questioning everything because they've had five providers, neurologists, doctors, whatever before you.
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Sometimes they're pushing because they don't understand why progress isn't happening quickly enough.
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And sometimes they're really just being unreasonable.
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Let's be honest.
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But we don't have to decide which one it is before we listen and we ask.
00:08:23.920 --> 00:08:27.040
So here's a framework I want you to try.
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I call it protect the clinician, preserve the relationship.
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So first, protect the clinician.
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Make sure your BCBA knows I have your back.
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You don't have to tolerate disrespect.
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You don't have to agree to something clinically inappropriate.
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I'm going to support you through this.
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That matters because clinicians who don't feel supported eventually stop bringing problems to leadership.
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And that can be dangerous.
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But then comes step two, preserve the relationship.
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Now we turn towards the parent.
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And instead of saying something like, let me explain why the VCBA did what she did, we start with, help me understand what has been frustrating you.
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What were you hoping would happen?
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What feels like it isn't working right now?
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What would you need from our team to feel more confident moving forward?
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Now we're not defending, we are listening.
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And once the parent feels heard, you actually have a much better chance of being able to explain the clinical perspective.
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And again, don't take this the wrong way.
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I'm not saying that there's not going to be a point where the parent is just not getting it, I guess, or we've spoken with them a couple of times and it's not happening.
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Or the BCBA just doesn't want to work with the parent because I don't know, it reminds them of someone else, or they've already had it and they're to a point of frustration.
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And at that point, well, you have to step in and make these difficult decisions, and that's fine.
00:09:55.759 --> 00:10:01.200
But let's first make sure that we are communicating effectively.
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Now, let's talk about the business side for a second because we're clinicians.
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We're also running an organization.
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When a parent leaves, it's not just, oh well, we'll get another client.
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There's a child losing continuation of care.
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There's a family that's losing a relationship.
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There's a BCBA losing a case they've invested already in.
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There's a team that has no transition.
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And yes, there is a business impact.
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We shouldn't be ashamed to acknowledge that.
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Retention matters.
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But here's what I don't want leaders to do.
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Don't save the client at the expense of your clinician.
00:10:36.799 --> 00:10:43.600
Because if the message to your BCBA becomes whatever the parent wants, give it to them because we can't lose that case.
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You will eventually burn out your clinical team.
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And then you have a different retention problem.
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Your best clinicians will leave.
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So the goal isn't parent at all cost and it isn't BCBA at all cost.
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The goal is a sustainable relationship where their clinical team can practice ethically and the family feels heard, respected, and most importantly included.
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That's the sweet spot.
00:11:08.799 --> 00:11:12.799
So here's a question I want every clinical director to ask themselves this week.
00:11:12.960 --> 00:11:21.279
When a BCBA comes to you frustrated about a parent, before you decide where you're going to do, ask, what does the BCBA need from me right now?
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Do they need validation?
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Do they need coaching?
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Do they need help setting a boundary?
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Do they need you to join the conversation?
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Or do they need you to challenge their interpretation of what's happening?
00:11:33.120 --> 00:11:34.559
Because those are different things.
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And then ask, what does the parent need from us right now?
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Those answers might be completely different.
00:11:40.960 --> 00:11:41.840
And that's okay.
00:11:42.080 --> 00:11:45.120
Your job as a leader is to hold both.
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So if you're a clinical director, an owner or a leader managing BCBAs, I want you to remember something.
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Supporting your clinician doesn't mean taking their side.
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And listening to a parent doesn't mean taking theirs.
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Leadership is being able to say, I understand why you're upset to your BCBA.
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And then turn around and say, I understand why you're upset to the parent without making either to be the enemy.
00:12:09.679 --> 00:12:12.080
Because the goal isn't to decide who's right.
00:12:12.240 --> 00:12:16.159
The goal is to create enough trust that everyone can get back to work.
00:12:16.399 --> 00:12:19.279
And sometimes that means protecting your BCBA.
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Sometimes it means coaching them.
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Sometimes it means setting firm boundaries with the parent.
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And sometimes it means saying we could have handled that differently.
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And my friends, that is leadership too.
00:12:31.360 --> 00:12:35.360
So it's not whose side you want, is how do we make this work?
00:12:35.519 --> 00:12:40.000
I do a bunch of these trainings for clinical teams.
00:12:40.159 --> 00:12:43.840
And I actually had a conversation with a clinical team today.
00:12:44.080 --> 00:12:47.679
And they desperately wanted me to start tomorrow the training.
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And I was like, well, I can't tomorrow.
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But they were telling me all of the challenges that they were experiencing in this team.
00:12:55.360 --> 00:12:58.000
And we were able to set up a time to meet.
00:12:58.080 --> 00:12:59.440
And that's what I like doing.
00:12:59.679 --> 00:13:13.120
When people reach out to me and they want me to do these motivational interviewing trainings for their team, I first meet them on a call because I wouldn't be a good MI trainer if I wasn't doing what I'm preaching.
00:13:13.200 --> 00:13:22.720
And I first want to ask those questions to better understand what's going on, to better understand their clinicians, to better understand the challenges that they're experiencing.
00:13:22.960 --> 00:13:30.000
So I'm so glad that we were able to set up that meeting and that call because now I know exactly what their team needs.
00:13:30.159 --> 00:13:40.879
And if you're an owner of a company, if you're a clinical director and you want your team to get training on motivational interviewing, you want to be part of it as well, contact me.
00:13:41.039 --> 00:13:41.600
Let me know.
00:13:41.679 --> 00:13:46.639
We can set up a meeting, we can talk about it, we can see what's going on, and then we can plan ahead.
00:13:46.799 --> 00:13:53.759
We can customize a training that fits your budget, that fits your needs, and most of all fits your clinicians.
00:13:53.919 --> 00:13:57.759
So thank you all for being part of this episode today.
00:13:57.919 --> 00:13:59.360
I hope you found value in it.
00:13:59.440 --> 00:14:00.960
I'll see you next time.
00:14:02.639 --> 00:14:06.639
Thank you for joining me on today's episode of MI for Change.
00:14:07.120 --> 00:14:21.440
If you're ready to keep growing your motivational interviewing skills, I'd love to invite you to explore my MI Academy, where you'll find a full library of on-demand courses designed to help you put MI into practice with confidence.
00:14:21.679 --> 00:14:28.320
You can learn more at www.drmonicagilbert.com.
00:14:28.559 --> 00:14:32.879
Until next time, keep asking the questions that spark change.
