Clinical Leadership in Autism Care with Dr. Rue

Dr. Hanna Rue is a leader and a driving force in the implementation of best clinical practices for people with autism and their families.

Her list of accomplishments includes leading the National Standards Project, which is the second iteration of the largest systematic review of educational and behavioral literature for autism. Now, as the Head of Clinical Development at the LEARN Behavioral Network, Dr. Rue and her team are on a mission to develop a nation-wide clinical infrastructure that will increase the standard of care for autism and provide much-needed services to thousands of families across the US.

We are honored to have had the opportunity to speak with Dr. Hanna Rue. In this exclusive blog post, we detail some of the challenges that come from being on the leading edge of service provision for autism. We also discuss exciting technology opportunities and share Dr. Rue’s advice to aspiring behaviorists.

We hope you enjoy this post! Read to the end to find out how you can get in touch with LEARN and Awake Labs.

During this phase of rapid growth at the LEARN Behavioral Network, how do you maintain trust and integrity in your services?

It really comes down to the people in key positions, communication, and scalable system design. When you have motivated and talented people in leadership positions anything is possible.

Our clinical leadership includes individuals with years of experience working with families and clients in a variety of settings. All of our clinical leaders maintain some work in the field. This allows for opportunities to model best practices for other clinicians and is important to determine the impact that new systems or changes may have on the families we serve.

Ongoing communication is also critical and we maintain standing meetings that include data-based decision making at a systems level. We’ve adopted systems such as Feedback-Informed Care (FIC) that allows us to monitor each family’s perception and satisfaction with service delivery. Systems such as the FIC are piloted with a relatively small group of clinicians and families and then rolled out to the rest of the company in a systematic manner. This allows leadership to address any issues and ensure all necessary supports are in place before we expand the system.

As diagnostic rates increase, more families find themselves stuck on waitlists; how does building a nation-wide infrastructure help address this challenge?

It is an unfortunate truth that there aren’t enough BCBAs in the U.S. to meet the need. We set up our regions and centers with a focus on having people with knowledge of the community. It’s important to maintain close relationships with local physicians, hospitals, and community groups to understand the availability of resources. We work hard to avoid waitlists and maintain contact with our families on waitlists. If a family is on a waitlist for an extended period of time, we will make every effort to find a quality provider to get the family access to services.

Our agency maintains a really active recruiting effort and we have the ability to offer positions across many different regions in the U.S. Many of our clinicians are guest lecturers in university-based BCBA programs and undergraduate programs. Using this platform, we can highlight the many benefits of working with individuals with autism and inform students of the great need in the industry. This not only helps our recruiting efforts but also the field, as it may inspire some undergrads to consider ABA as their career choice.

Based on the results of the 2015 National Standards Project, where do you think the research community should concentrate its efforts in order to have the most impact for people with autism and their families?

What was surprising was the lack of studies regarding the use of technology. We certainly reviewed more studies involving technology in the second iteration of the National Standards Project. I think there is so much more to learn regarding the use of technology and ABA for individuals with autism. The second iteration of the NSP included an evaluation of interventions for adults (i.e., individuals 21 years of age and older). It was troubling to only have 28 studies meet criteria for inclusion in the review. Children with autism grow up to be adults with autism who can benefit from applied behavior analytic strategies. I think focusing on effective strategies for adults with ASD is imperative.

What are some of the most exciting technologies currently available to clinicians? How will these technologies ultimately change the clinical landscape?

There are still many clinicians who have yet to use electronic data collection systems. It is exciting to work with clinicians learning to use this technology, as there is often a dramatic increase in efficiency regarding programming and visual analysis of graphical data. Telehealth is another useful technology for behavior analysts. LEARN clinicians make use of video conferencing for clinical direction, parent consults, collecting independent observer assessments (IOA), and training. Video conferencing keeps clinicians across the country connected and enhances collaboration.

Several LEARN clinicians have been using virtual reality (VR) headsets to evaluate how the technology may contribute to skill acquisition programming. I think VR may offer increased learning opportunities for some of our clients. We’ve worked on teaching joint attention using VR and considered VR for safety skills training as well. Finally, I’m really excited about wearable technology. I think there is more research needed to determine how wearable devices might help clinicians develop more sophisticated programming around reducing challenging behavior.

You oversee a lot of graduate research projects. How do graduate students impact LEARN and the day-to-day activities in your clinics?

Graduate students are tremendous assets to LEARN. They are motivated and curious. By supporting graduate students we are shaping future clinicians who can grow to be leaders at LEARN and in the field of behavior analysis. The science of behavior analysis is evolving and applied techniques are becoming more sophisticated. We can contribute to our greater knowledge of the field by having opportunities for clinicians to engage in scholarly activities such as practicums and thesis projects. The majority of our graduate students are focused on single-subject research projects that lead to improvements in client treatment plans.

I think in terms of day-to-day activities, the grad student projects enrich our programming. The behavior technicians become involved via data collection and often consider pursuing an advanced degree and that is really exciting. The projects also highlight to our clinicians the importance of scholarly activity while engaging in service delivery.

There are more and more people interested in pursuing a career in behavior analysis. What advice would you give to new professionals in this space?

Take time to explore all of behavior analysis. Many clinicians work with individuals with developmental disabilities but behavior analysis is so much more. I so value my time in an operant lab. I truly think it helped me to better understand the impact of the environment on behavior. There are also incredible opportunities in areas focused on animal behavior, gambling behavior, substance abuse, and organizational behavior management just to name a few. Listening to leaders in the field like Dr. Pat Friman discuss the vast possibilities of behavior analysis in our world is truly inspiring and may pique your interest in something you’ve not previously considered.

Call to action!

The LEARN Behavioral Network is growing rapidly. If you would like to get in touch and learn about existing opportunities, send an email to info@learnitsystems.com

Do you have an idea for a blog post that you’d like to share with Awake Labs? Send an email to paul@awakelabs.com with the subject line “New Blog Idea!”