As the first webinar in CentralReach's Branch Out Series, Dr. Cohen and Dr. Cameron discuss communication skills in clinical settings.

1. Critical Conversations
October 30th 2015
Michael J. Cameron,
Ph.D., BCBA-D and
Leslie Cohen, Ph.D.,
BCBA-D
ObiGobi ACE Provider
OP-15-2552 Type 2 CEU

2. Agenda
Mechanics of the
Webinar
Build your Critical Conversation
Skill Repertoire
Increase
collaboration and
good clinical work
Increase your
ability to “name”
ethical concerns
that arise in the
course of vital
conversations
Anchored
Instruction and
Real Clinical
Issues

3. Mechanics
At conclusion of the webinar,
you will complete a survey
and short quiz (5 questions.
A score of 80% is required).
You will receive a certificate
of completion with our ACE
Provider information
You will receive 1.0 CEU for
participation. The webinar
qualifies as an ethics
training. We will cross
reference our discussion to
the BACB’s ethical
compliance code
01
02
03

4. Stakeholders
Communication with a
Network of
Stakeholders

5. More Outcomes
Superficial
Thinking
6 of 10 doctors
visits related to
stress
40 million on
anti-depressants
Stress Impact
Bouts of Irritability
Lethargy
Fatigue
Headache
Muscle Tension
Insomnia
Weight Gain
Karoshi
The Reality of Communication
Demands
Management
High Frequency
Long Duration
Diverse Forms
Medium Shifts
Phone
Email
Text
Teleconference
Meetings
3rd Party

6. Definition of a Critical
Conversation
01
Stakes are high
02
Critical conversations
are important, and
can quickly become
crucial:
03
Emotions run
strong
Opinions vary
Taken from the book
Crucial Conversations, Kerry
Patterson, 2002

7. In Writing
• Not editing your
work (e.g.,
wrong name in
a report)
• Delivering bad
news by email
or text
Toward a Taxonomy of Communication Errors:
Communication Error Types from a Conversation
Analyst
In Person
• Avoiding
difficult
conversations
• Not being
assertive
• Reacting, not
responding
Anticipatory
• Not preparing
thoroughly
• Using a “one-
size-fits-all”
approach
• Not keeping an
open mind

8. The Deconstruction of Communication
Failure and Success
There are a thousand hacking at the branches of evil
to one who is striking at the root
Henry David Thoreau

9. Conversation Network Members
You
Other
Professionals
Parents
Employees
Clients

10. 10 Heuristics and Biases
for Crucial Conversations

11. 1. Tact the Circumstances
“I am having a critical conversation”
“This needs to be addressed”
Chicago. Just before the start of
an IEP meeting, Kirsten was told by
the school principal to not recommend
the continuation of 1:1 services for a child
San Francisco. Piers tracks his BCBA
cancellations and learns that one of his
supervisors has not visited a family’s home for
two months

12. 2. Mind your own Wake
Responding, and not responding, to the need for a critical conversation will produce
a behavioral “wake”

13. Mind your own Wake
Austin. Within the context of a supervision meeting with a direct service provider, Andrea
(a BCBA) learned that her mentee accepted the gift of a used car from a family she has
been working with for two years.
Seattle. Paulo, the new Clinical Director for a for-profit company that delivers behavior
analytic services to children with autism and their families, sent out an email to all his
Board Certified Behavior Analysts (many which he has never met) informing them that he
was requiring a 20% increase in the number of billable hours they did on a monthly basis.

14. Mind the Wake
We have more
possibilities available in
each moment than we
realize.
Thich Nhat Hanh

15. 3. Mind the Gap
Stimulus Response
Choice
There is a gap or space between stimulus and response and the
key to your communication success is how you use that space

16. Mind the Gap
Indianapolis. At 7:00 AM on a Monday morning Chief Clinical Officer
for a corporation that delivers behavior analytic services to children with autism and their
families, received a call from his senior Board Certified Behavior Analyst.
The BCBA reported that she had been receiving text messages from a
client’s father since 5:00 AM (Samantha never gave him a personal cell
phone number). The father was demanding that the BCBA write
a letter to support him in a bitter custody battle. The BCBA needed
immediate support.

17. 4. Choice Making
Once your scenarios are outlined, and the potential consequences are thought through,
design your plan of action.
Los Angeles. As a result of the unethical conduct of a psychologist that worked for a major
funding source, a Chief Clinical Officer for a large corporation was faced with a decision:
(a) discuss the ethical violations with the psychologist (from the funding source) and risk
the loss of current clients or new referrals, or (b) remain silent about the violations in
order to preserve the relationship and the referral source.

18. 5. Notify Stakeholders
If you plan to have a crucial conversation that may impact stakeholders, notify the
stakeholders in advance. Surprises are for birthday parties.
Salt Lake City. As a result of having to terminate services with a family, as a result of giving
a child with autism chlorine dioxide (C0102) enema’s five to six times per day, the
insurance company was notified after the family confirmed the treatment they were using.
The clinicians on the case also worked with the family, step-by-step, during the
child protection reporting process.

19. 6. Analyze Behavioral Contingencies and Conduct a
Scenario Analysis
The reason behavioral contingencies are of
practical significance in the management
of human affairs is that they can be
manipulated. Unlike the other major
determiners of behavior, like personal
histories and the realities of physics and
biology, behavioral contingencies can be
installed, modified, adjusted, and
designed.
Dr. Francis Mechner

20. 7. Fair Pair
Progressive Acknowledgement and
Discipline
The way positive
reinforcement is carried
out is more important
than the amount.
B. F. Skinner
When possible, establish yourself as someone that delivers genuine “educational”
reinforcement to others. Your reinforcement history will matter.

21. 8. Brace for Punishment-Induced
Aggression
Aggression and
Violence
Broken
Relationships
Counter Control
and
Activation of a
Response
Repertoire
The Result of
Doing Nothing

22. 9. Conduct a Threshold Analysis
Ivan Pavlov
• Magnitude and parametric analysis
• The importance of understanding thresholds
(your own, and those of others)
• Your behavior should be under audience control
• Conversations, especially crucial conversations,
can have thresholds
• The role of behavioral momentum
during conversations
A PILOT STUDY OF NATURALLY OCCURRING HIGH-
PROBABILITY
REQUEST SEQUENCES IN HOSTAGE NEGOTIATIONS
JAMES HUGHES
YORK CENTRAL HOSPITAL

23. 10. The Death of Dr. Martinez
North America. Dr. Martinez was pressured into discharging children (who were benefiting
from services) from a government funded program for child with autism spectrum disorder.
• Learned Helplessness
• The stimulus equivalence paradigm
• Finding your voice within your own personality

24. Behavior Analysis of Effective
Communicators
01
• Be relatable
• Emphasize key
points through
repetition
• Humor
02
• Listen
• Respond in a
timely manner
• Analogies are key
03
• Adapt readily
• Be present
• Find your voice
04
• Write everything
down
• Put your audience
at ease
• Customize your
communication
• Ask before you
speak