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Hi everyone.
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Welcome to Around the Spectrum where parents, pros and those in between pull up a chair for honest conversations, grounded guidance and real stories about raising and supporting autistic children.
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I'm your host, Wendy Manganiello.
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As a parent, marketing leader and longtime autism ally, I know how overwhelming and isolating this journey can feel.
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That's why we're here, because when we sit at the same table, we understand more and judge less.
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Let's get into today's episode.
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This episode zooms out a bit.
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We're talking about leadership in centers today and how leadership in those spaces impacts real families.
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If you're ever wondering why does this feel so hard, or is anyone listening?
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This conversation is for you.
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Today we have Amanda Cox with us, and Amanda is a leadership development trainer and consultant with a master's degree in leadership development.
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She owns and operates the Know Better Company, where she supports businesses with her employees and leadership's development, including three ABA clinics in Indiana, and she has served over 1,000 individuals through training and coaching all over the world.
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Has served over 1,000 individuals through training and coaching all over the world.
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She also coaches for the worldwide EAP Spring Health, where she serves clients from Fortune 500 companies such as Microsoft, BNY, Mellon, Nestle, Allstate and more.
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Amanda now offers comprehensive training and coaching for all AB professionals to expand their social skills for retention, improved work life and stronger client outcomes.
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Welcome, Amanda, I'm so glad that you're here, Wendy.
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Thank you so much for having me.
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This is not Amanda's and my first podcast together.
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She has been a guest on my self-care podcast, wellness and Wealth.
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You can go listen to that.
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She was on about two years ago.
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This one is all about families and nonjudgmental talk about raising children with autism.
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There's so much information out there and it's overwhelming.
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To any parent who has gone down the Google autism rabbit hole, it's one of the first things you're told as a parent is to get eBay therapy.
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There are people who eBay is the most wonderful thing in the world, and then there's a lot that don't believe that.
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I think some of that starts with leadership, because if you have a great eBay company that really is family focused, that makes a world of difference in what you're going to get and the expectations that are set for you and your family Talking to you about that, because this is what you really delve into leadership and why it's important.
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So what's your why?
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Because I'm always fascinated when people are not directly connected that become BCBAs or leaders of these ABA therapy.
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Great question.
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I have been consulting with an ABA owner CEO for almost five years now.
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Her internal has been only the three clients I oversee for leadership development training in Indiana.
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I've been working with her and it was so organic.
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She was telling me about her client struggles, employee struggles and relationships within the clinic.
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This is what I do professionally and I was like wait, I want to know what does RBT mean?
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All of the acronyms and different things.
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I started getting more and more curious.
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I started getting more and more curious.
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My why is meeting these wonderful human beings that have dedicated their lives, their professions, their careers to helping the most vulnerable people in our population, like children with neurodivergencies and autism, and helping them grow and be better leaders.
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And, honestly, that has become such a great purpose for me.
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I have seen many BCBAs that started as RBTs, that took the test, and I've been with them for five years, helping them cultivate that journey and, honestly, just seeing them flourish as professionals because they have more capacity and more confidence.
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They translate that into the work with their children.
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To me, it's fairly obvious what my why is, and that's truly developing those professionals to help them be the best they can be for their children.
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To me, it's fairly obvious what my why is, and that's truly developing those professionals to help them be the best they can be for their clients.
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I love that and I think that's so important as a parent.
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Knowing that somebody is trained in autism care and ABA, that's really important, but also some of those soft skills that go along with that.
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Because they are going in and out of families' homes, a lot of people bring their children to the centers too, but being able to have those interactions on both levels makes a huge difference leaving your child with somebody or inviting them into your home.
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So, in your experience, what are some of the most common challenges clinical leaders face, not just on paper but in day-to-day of working in ABA?
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Yeah.
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So thank you for sending all these questions ahead of time, because I was able to think about it.
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I'm just going to say the one thing that I think is a giant overarching thing.
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Like I mentioned, I've worked with dozens of BCBAs, rbts, admin.
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At this point, I've also asked hundreds of people.
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So if you're listening to this podcast and if you got a DM for me on Instagram over the last month, I've literally been messaging people like what are you struggling with?
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They want to hear the struggles.
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The number one thing that keeps coming up is that in one minute you're talking to insurance and next minute you're talking to admin, and next minute you're talking to a brand new RBT who is their first job.
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The next minute you're coaching another BCBA and the next minute you're pairing with a client.
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You have to be able to switch all of those off and on quickly, right in those high environments, kids are playing, music is going, your phone is buzzing and your team's messaging is going off.
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You're also expected to be the calm, the chaos, on top of being able to literally switch the way you communicate and your brain constantly, because we talk differently to a professional with insurance over the phone than we would with an RBT differently than we would have been doing.
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The schedule For me, I think that is the biggest challenge when it comes to these professionals navigating the chameleonism in a setting that is so different than everything else.
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Is this making sense?
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Yeah, absolutely, I was a director of five different grants with different sets of employees for each grant.
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I'd be talking about one thing one minute and then the phone would ring and I would talk about something else.
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As somebody who has ADHD, which is another neurodivergent thing, my brain works well like that, but for a lot of people that is a learned skill to be able to switch on and off you come home tired because not everybody lives off of that organized chaos, for lack of a better word and being able to adjust the tones to who you talk to and how you talk to and when you talk to.
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Could you imagine being on the phone with someone with insurance explaining what you need and then, all of a sudden, the kid's in a behavior?
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So obviously I have to come up and the parent comes in and you're explaining that behavior and how differently you have to convey empathy and professionalism, but also make sure that you're doing your job and representing a clinic.
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Those are three very real things that could happen in less than 15 minutes with these professionals.
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A hundred percent I love what you just said needs to be taught, needs to be learned, and that is my entire business philosophy and leadership philosophy.
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You're doing the best you can until you know better.
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That's why it's the Know Better Company.
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Maya Angelou says do the best you can until you know better.
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Know better, you can do better.
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And that's where I come in at teaching these things no assumption, no shame, no guilt.
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No one ever taught you to communicate three different ways to match your audience.
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You've just been communicating the best you can, the way you were taught.
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That gives my clients a lot of I'm sorry I know.
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The word clients, right, is so funny because we refer to like the kids we serve as clients sometimes, but so when I'm saying client, I'm meaning the people who I'm training in leadership development, soft skills Maybe I should just say my BCBAs right and giving them a lot of confidence and saying no worries about not knowing.
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Perfectionism is not required From here on out.
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Let's just give you the awareness that changing that communication style is going to help you with your relationships.
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Ultimately, that's what we're looking for.
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I think that's really important.
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We're talking about communication.
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Actually, I'm in a lot of BCBA groups and I was just reading something this morning about wanting to quit.
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She's been a BCBA for years and because she doesn't have a child, parents feel like she doesn't understand what it feels like.
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If you have somebody who's worked in the profession for a very long time.
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It's about the communication thing.
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I think there's two sides to that coin, right.
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It's about the communication thing.
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I think that there's two sides to that coin, right.
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It's really important for BCBAs to come over to the parent's side to see where the parent is coming from.
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We all come in with our own backgrounds as parents.
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Some of us are more organized than others.
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Some of us are more on top of things than others.
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Then you have the BCBA who's trying to bring in consistency.
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I'll be the first to admit, when we talk about communication and consistency, my son.
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Because I didn't know I had ADHD until I was probably two years ago.
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I was going to be that mom that had no consistency.
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We were going to just do things and have fun.
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My son's diagnosis actually led me to processes, tasks, consistency and better communication For myself because I suddenly had to do it for somebody else.
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As we have this communication and leadership.
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When you're changing all of these hats, you have to be aware what it's like to be a BCBA that has no children but it dedicates their life to kids and vice versa, the BCBA being able to come over to the parent side and see what it looks like when they go home with these kids every day and still have the rest of their life to contend with.
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I think that's another really important piece.
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So you often discuss trust-based leadership.
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How does it manifest in a clinical setting and how can leaders build it, especially when morale might be low or turnover is high?
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Oh, such a good question.
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When I saw this on the list, I was like we need to talk about that.
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So I want to define what trust-based leadership is first, if that makes sense.
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People might hear that and be like oh, buzzword, buzzword, right.
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Sometimes people think that trust-based means I trust you, no questions asked, no feedback.
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There's no hierarchy or power over it.
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Trust-based leadership is not like being nice all the time or being so reserved that you can't get feedback.
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It's not avoiding hard conversations, letting poor performance slide because you want them to trust you.
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It's really about clarity, integrity and that want to connect, which I am a strong believer in.
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Feedback is not conflict, it's connection.
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Key principles of trust-based leadership Number one is transparency, and I think in a clinical setting, if you are transparent, you are already going as you can be.
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We have HIPAA and privacy, but with your team, if you be as transparent as you can be, that's always going to be a great start for that trust.
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So what that might look like is making sure that your BCBAs are aware of new clients coming in.
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Clients fading out timelines for different ops.
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It might be looking like different schedule shifts.
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Why does this client a different RBT rule this week than last week.
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Understanding the why in a clinical space really helps people feel a little bit safer.
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It's that psychological safety that we're all looking for when transparency is at the front.
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My leaders communicate openly.
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The majority of the BCBAs and just RBTs that I work with they're that like supportive type, meaning they are bleeding parts.
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They are similar to teachers and nurses in this way where they want to do everything for everyone all the time and have this kind of like I'm okay.
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I'm okay, everything's fine.
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I need to help others, but sometimes that lends itself to being reserved and not saying I need help or this is what actually is going on.
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So to really try to lead with that trust-based leadership model, number one is going to be transparency.
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It doesn't always mean avoiding conflict, so I hope that answers that question.
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Burnout is really real in this industry.
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Part of the issue is the lack of real conversation.
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And then there's the burnout parents feel when they have to leave agencies or providers because another RPT quits, leaving their child without support.
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So there's a two-sided thing, and the fact of the matter is that, if we're being honest, we have more children with autism than we do, BCBAs and RBTs alike.
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The ability to take care of them and not because we can give everybody what they want on both sides there's other dynamics there, but the ability to listen and draw some boundaries on both sides so that it works for both the parents and the providers is a really important piece that sometimes is's not discussed.
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One of the things that I used to do in my own job is by state.
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You can look this up.
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You can Google what BCBAs are unhappy with, and it does vary from state to state.
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Instead of looking at leadership, it starts to become this is the standard here.
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So this is what we're going to do, as opposed to uplift the standards, so that you stand out and you're actually given the best care to both.
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So that brings to the next question, which is you're known for helping leaders navigate hard conversations.
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That doesn't mean that BCBAs get everything they want, nor does it mean that parents get everything they want.
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We do have things like insurance agencies and governmental regulations.
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There's a lot that goes into the eBay field.
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What does that look like in an eBay clinic to have those hard conversations?
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Yeah, going back to the personality that I mostly work with, that supportive type, more perfectioning, fear of conflict, not wanting to upset anybody, because they are such big hearted people and want to make everyone happy and make everybody feel good.
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Normally that hard conversation is kicked down the road.
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It starts with just having it.
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I have done mock hard conversations, outlines, trials in groups, anything to just get the words out of your mouth is where we have to start.
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I am a big believer in teach people how you want to be treated.
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Even if you have been somebody who doesn't give feedback and doesn't speak up for the last 20 years, you are allowed to change that.
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Today you are allowed to start changing how you want to be treated.
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You reserve the right to evolve, to change, to learn, to grow.
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It starts with people understanding how you need to communicate for them to be successful and vice versa.
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In that clinical setting, when we're having these conversations right, because even the label hard puts a negative connotation on it.
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Right, so we can call them critical or vital that urgency is so important.
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I'm fine with conversations and the best way is frequency and normalizing.
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We don't need feedback to be overly positive all the time.
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We don't want feedback to be overly negative all the time.
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My job is to come into clinic spaces and neutralize feedback, meaning normalize it and have it at a cadence that is continuous.
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The employee always gets weirded out and say well, you came out of nowhere and gave me feedback first time six months and that's okay.
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You just say allow me to reintroduce myself.
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I am now a supervisor that gives feedback more frequently.
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On the flip side, from somebody who's been in the industry for a long time, read that study Soft Skills right, the softer side of supervision.
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From the American psychology papers I read that BCBAs more than 50% of BCBAs got certified 2019 or later.
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So we're talking about young professionals that haven't been in the workforce.
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Maybe they were teachers before or have some background, but really we're talking about young professionals that haven't been in the workforce.
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Maybe they were teachers before or have some background, but really we're talking about people who are 24, 26, 28 years old that really haven't been in professional settings yet because they've been in grad school or working up to this level of professionalism.
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So in a clinical setting, it really is important from the very beginning.
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When we're in our student program or in our master's programs, we're also practicing giving that feedback.
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Absolutely, and, interestingly enough, I had the chance to do some hiring at the companies.
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I worked for initial interviews, that type of thing, and I was very taken back and this could have been a byproduct of COVID.
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I had people who were like I went to school for this.
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They weren't necessarily going to school for BCBA, but they were maybe going to come in as a BT or RBT.
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I interviewed some students in making for BCBA also and we would have them come into the clinic to shadow an RBT.
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I'm all all about schooling.
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I have no issues with that whatsoever, but you have to be able to interact with children.
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There's a lot of analytical side applied behavior analysis.
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Obviously the whole thing is analysis.
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I was surprised, as you're saying, about the study in 2019.
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I really think at that time it was a byproduct of COVID.
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How many people had never been by a child with autism?
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And they were really taken back of what it really takes to be able to physically, mentally, show up each day and I felt for them.
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That's a lot of money to spend on school for something that you really want to do more of the academic side, because the academics weren't matching perfectly to what the behaviors were right.
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This is what it's like on paper, and then this is what it's like when you're in the clinic setting and a child is being who they are.
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It's a really interesting thing that you bring this up, because I'd love to see a study of that, like of how many people missed the ability to do those supervision hours.
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Some people were starting it after school as opposed to prior to or while going to school.
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It's an interesting thing because it's having those conversations that you know you even belong in that.
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Setting for yourself eye-opening On the other hand, setting for yourself eye-opening, on the other hand.
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There are some miracle BCBAs out there.
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I've seen BCBAs who just run circles around everybody in a building and are able to be there instantly each child it's just amazing and get supervision feedback to the RBT of this is how we handle this better.
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So I know that there's a lot going on in clinic setting.
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So how do you coach someone, especially when you have kids who might be acting out or still working on their behaviors?
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How do you coach someone to stay calm and grounded during all those times?
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Because if you've been in a clinic, it could happen.
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You have various children acting in different ways at the same time and, especially for a BCBA, especially when their attention is all over the place.
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So how do you keep them grounded and have those calm conversations with their RBTs when emotions are running high or there's an upset?
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parent.
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I'm going to have everybody take a breath.
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When you just asked that question, floods of information just came.
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I'm going to take you through my whole thing.
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I really hope this is going to take you through my whole thing.
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I really hope this is going to be the meat of the podcast, where people really take away things.
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First, I start with biological readiness, and this is so simple, but the first thing that BCBAs forget to do is take care of themselves.
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I'm talking about bathroom, water, eating, brushing their teeth.
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When we are not biologically ready in our body, we cannot handle stress and chaos like we can if we are.
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If I show up to a parent meeting and I haven't eaten I have overdone it on caffeine, I haven't had any water today that parent meeting is going to go very differently than if I had a sniff and drank my water and emotionally and socially, I was feeling a lot more safe and confident and comfortable in those relationships.
00:19:56.019 --> 00:20:06.376
As supervisors, as CEOs, bosses, directors, leaders whatever you are you need to be checking on biological readiness for all healthcare workers, period.
00:20:06.376 --> 00:20:12.176
I have 20 friends that are like I don't have time to drink water, I don't have time to use the bathroom Right there.
00:20:12.176 --> 00:20:18.202
That's a cultural issue, because what we're saying is at this job, you don't have time to use the bathroom.
00:20:18.202 --> 00:20:21.885
You're asking a human being to not be a human being.
00:20:21.885 --> 00:20:26.194
When we start doing that, we're already gonna start losing and that's gonna be burnout.
00:20:26.194 --> 00:20:29.257
So biological readiness is important.
00:20:29.798 --> 00:20:41.843
If you have one-on-ones which I highly recommend weekly, if not bi-weekly, with all of your BCBAs to get a feel from what they're doing, that would be the first question I ask them how are you taking care of your biological readiness?
00:20:41.843 --> 00:20:54.007
If you think about your body as a glass and you're all the way sealed up to the top and a little bit of turbulence happened, all the water's pouring out, you're not going to be able to have that conversation.
00:20:54.007 --> 00:21:00.978
But if your energy is just midway and you're calm and there's a little bit of turbulence, you're not spilling out all over the place, right?
00:21:00.978 --> 00:21:14.320
That's the number one thing you need to focus on getting them ready, because we are teaching everyone around us as BCBAs, as leaders, to act, to be.
00:21:14.320 --> 00:21:15.242
This is how we are.
00:21:15.663 --> 00:21:27.502
And if the supervisor doesn't take care of themselves, doesn't uncap me, doesn't drink water, doesn't eat, you betcha that the trainee is going to also model that behavior, because what is that trainee thinking.
00:21:27.502 --> 00:21:30.368
This person is who I want to be when I grow up.
00:21:30.368 --> 00:21:39.622
And in order to be a successful BCBA or clinic director, I can't drink water, eat or take care of myself or use the bathroom, so we're just modeling all of that.
00:21:39.622 --> 00:21:44.123
I feel like there was one more point that you wanted me to get to, or is that everything?
00:21:44.884 --> 00:21:47.048
You know that's really good about running high.
00:21:47.048 --> 00:21:54.596
In fact, I did open a center for one of the companies I work for when I was training in the other centers for that position.
00:21:54.596 --> 00:22:00.261
One of the things was, as a great center director, you go around every and see who needs a break.
00:22:00.261 --> 00:22:12.490
Yeah, do that, because otherwise you do have burnout with your clients and you're going to be very tired at the end of the day and very impatient.
00:22:12.490 --> 00:22:27.198
I have to say that I've just found the RBTs to have such great horror about the kids they work with, because the patience it takes to work with the same child, sometimes day in and day out, is nothing more than, some days, supernatural.
00:22:27.198 --> 00:22:31.931
But, as you were saying, in order for that to happen, they have to feel calm and ready.
00:22:32.405 --> 00:22:37.615
We were in a culture for a long time that said never bring anything from home into work.
00:22:37.615 --> 00:22:39.411
I'm sure you know about this right.
00:22:39.411 --> 00:22:47.332
So when it comes to working with kids, you want to make sure that your child has consistency, which the child sometimes needs as part of their assessment.
00:22:47.332 --> 00:22:49.010
One of the things may be consistency.
00:22:49.010 --> 00:23:03.517
How do you allow leaders to balance the fact that they may be bringing in their stuff and not have it come out while working with children, because I don't believe you get into work and everything is gone for whole human beings and it's really hard to do that.
00:23:03.517 --> 00:23:10.538
We work with a very fragile population that can bleed into if there isn't some sort of balance.
00:23:11.085 --> 00:23:14.759
So I think this is again you alluded to its higher level.
00:23:14.759 --> 00:23:19.712
It's not just about people working in clinics, it's just people being people.
00:23:19.712 --> 00:23:27.848
We all went through the era of Brene Brown and vulnerability and got misconstrued about what vulnerability, appropriateness actually is.
00:23:27.848 --> 00:23:32.394
It's being able to say how you're feeling at appropriate times and appropriate moments.
00:23:32.394 --> 00:23:35.747
Not keeping it all in, but certainly not spilling it all over the place.
