Stronger Together: Care Collab

Why Check-the-Box Care Collaboration Does Almost Nothing

Most behavior analysts book a few care collaboration meetings (meetings with a client's other providers) each month. In the live chat poll, most answers were low: zero to five meetings in a rolling 30 days was typical. Harrington said he sat in that same range for most of his years in practice. The count is not the real issue. The purpose behind the meeting is.

He made the case with an assessment analogy. Think about a functional analysis (a test that finds why a behavior happens). You would never run one on a behavior you do not plan to treat. The data would sit there and change nothing. Meetings work the same way. A report you send just to send a report does not move a goal.

Speech therapy is the clearest example. Many behavior plans carry language goals. The speech language pathologist (a speech and language expert) should not glance at your plan and wish you well. Their read should change how you teach. Your data should change how they teach. That back and forth is the whole point.

when done to check the box care collaboration is kind of useless

From the talk — Matt Harrington

What the Research Says, Mostly From Outside Behavior Analysis

There is not much research on care collaboration inside behavior analysis. So Harrington looked at healthcare more broadly. The story was steady across what he found. Team care helps. People are still the hard part.

He pointed to a 2022 article by Samar Weo and colleagues on doctors and nurses. That friction goes back a long way. Grand rounds (a team visit to each patient room) is a plain form of collaboration. Staff pushed back on it so hard that it had to be made a rule.

Another hospital paper looked at interprofessional training, where staff from different fields learn together. Three results stood out to him. Patient satisfaction rose. Caregiver education rose. Medical errors dropped, and so did length of stay. Our field spends hours on caregiver training, so that second number should get our attention.

Work on ABA and occupational therapy (care that builds daily living skills) named the usual barriers. Providers misread what other fields do. They use different words for the same idea. And sometimes people are simply unprofessional. Harrington sees this at home too. His brother is a pediatric OT, and the two once argued over weighted blankets. He wanted a functional analysis first. His brother talked about proprioceptive input (feedback from muscles and joints). They wanted the same thing for the child.

so when you step into care collaboration understand there will be conflicts it's not your fault it is the name of the game

From the talk — Matt Harrington

Ethics Codes and the 'Everything Is Behavior' Trap

Three codes from the BACB (the board that certifies behavior analysts) came up: 1.05, 2.02, and 4.02. They cover professional and scientific relationships, and services given in collaboration with others. They also cover involving clients and families in planning and consent. Collaboration is not a favor you do when time allows. It sits inside the job.

Then came the scope of practice (the work your training covers) warning. Many of us learned that everything is behavior, so the science applies to everything. That part is true. The leap after it is not.

Harrington learned this while his wife was finishing a master's in special education. She was training in the science of reading (how children learn to decode words). He watched her practice letter sounds in a mirror, again and again, to get each one exact. He had never once thought about that level of skill. Walking into a room and assuming you know best erases years of someone else's training.

Scope can also shrink on you. In a hospital feeding unit he could work with gagging, vomiting, and swallowing risk. A swallow study (an x ray of swallowing) was easy to get there. In private practice that backup was gone. A family asked for feeding work and he said no at first. They saw the doctor, got a swallow study, and he set up standing contact with that medical team. Then he took the case.

what that doesn't mean is that we are the experts in everything

From the talk — Matt Harrington

Consent First: Releases, and What to Share or Skip

Everything starts with a release of information (a signed form that allows provider contact). Many practices bury it near the end of a long intake packet. Harrington wants the opposite. Put it up front, or give it its own short conversation. Ask the family who else works with their child. Then say what you will do with that contact and why. He said families almost never turn it down once they hear the reason.

Should releases be done as needed or at intake? His answer is both. As needed keeps the list honest and keeps families from signing ten forms at once. A checklist at intake keeps busy clinicians from forgetting. Chasing a caregiver who has ignored a form three times costs you rapport (the trust you build with a family).

Once you have the release, start broad. Agree on the outcome before you argue about method. As a new BCBA he talked sensory diets with an OT team that was focused on handwriting. They were in two different worlds. After the outcome is shared, trade what works. One of his favorite questions to an SLP is how they taught a skill. Two weeks of natural environment teaching (teaching during play and daily routines) tells you the learner copies others well. Three months tells you to build observational learning (learning by watching others) first. Safety plans belong on the list too, since behavior can block another provider's session.

Leave out assessment scores, personal opinions, gossip, and any comment about the family that does not touch treatment. Under HIPAA (the health privacy law), get written informed consent and document what you shared. Apply the minimum necessary standard (share only what is needed) and use secure channels. Some states also require you to document collaboration attempts.

ultimately the caregivers have the first and final say in what is shared

From the talk — Matt Harrington

How to Get the First Meeting With Another Provider

The list is already in your hands. Most insurance intakes require you to record other services, provider names, and phone numbers. Thirty minutes of speech, twice a week, with a name attached is your starting point. Harrington treats that line as a task, not a form field.

His preferred opener is a three way email introduction from the caregiver. You ask the parent to connect you and the pediatrician, then you and the SLP, then you and the psychiatrist. This changes who you are on the other end. You are not a stranger with a release form. The family has already consented, and the provider has a reason to reply. Keep the caregiver on the thread unless they ask to step off.

Use the first call to set the frame. Clarify roles. Agree on shared goals and how each of you plans to get there. Set a rhythm for meetings and reports. Then ask a simple question: how would you like to receive my feedback, and how should I send you mine? That does not need a formal decision tree. It needs to be said out loud once.

Channel preference is real. Pediatricians, clinical psychologists, and sometimes psychiatrists want a phone call or an office visit. SLPs, OTs, and mental health therapists want a link on their calendar. Offer both in one short message: here are times I can call, and here is my scheduling link.

you are a key member of the team who's been introduced by the parent

From the talk — Matt Harrington

Bring Data to the Appointment, and Stay in Touch Between Reports

Before you attend an appointment with a family, prep the provider you are visiting. One question does most of the work. Ask what information they want you to gather ahead of time.

Psychiatry visits show why this matters. A prescriber often has to work from what the family remembers in the room. Now picture the same visit with sleep data, mood data, and behavior data graphed together. A two week spike in behavior that lines up with poor sleep changes the conversation. Harrington has seen sleep drive medication response again and again, in hospital work and in his current client work.

If you cannot attend, send the graphs to the caregiver and prep them. He sends them when he knows an appointment is coming, even without a reply. A caregiver who understands the basics can hold their ground when a prescriber asks whether to double a dose.

Between visits, run systems. Standard reports, shared data sheets, and a standing meeting every few months cut the mental load for your team. Formal contact alone is fragile, though. Eighteen months of quarterly reports gives you no history when a crisis hits. Short informal check-ins build that history. So does celebrating wins. Ask a provider to tell you the story of a learner's progress. You get rapport and useful information in the same call.

one of the key questions i like to ask is what information do you want me to gather prior to this appointment that will help you

From the talk — Matt Harrington

Handling Conflict Without a Credentials Contest

Conflict comes with the work. When he polled the room, plenty of people raised a hand. One attendee noted that their sharpest conflicts are with other behavior analysts. The thing to avoid is any move that puts you above the other person. You just do not understand. That is not how we do it. Here is my citation. Each one reads as a shove, so the other person shoves back. Now it is a contest over who has the longer string of letters after their name.

Treat drift like behavior you already know how to catch early. You would not wait for a full escalation. You would act as soon as you see precursors (small signs before a big behavior). The same goes for assent withdrawal (signs a learner wants to stop). If you sense that you and another provider are heading different directions, say something that week.

The language matters. I could be totally misunderstanding this. Please walk me through that part. Anything that puts you in the learner's seat lets the other person meet you on level ground. That is not weakness. It is the fastest route back to the plan.

Let data settle what it can. That does not mean backing an intervention with clear disproof behind it. It means staying open enough to build something together that is better than what either of you brought. Then document it. Not as a gotcha, but because you will likely sit across from that same provider at next year's IEP (individualized education plan) table.

the goal is not to uh be smarter the goal is to get the client to uh the end place as efficiently as safely as possible

From the talk — Matt Harrington

The Business Case, and a 30 Day Plan to Start

Billing varies. Working telehealth in Virginia, Harrington had a billing code for collaboration. It covered roughly an hour to an hour and a half a month. In Florida, to his knowledge, there is no billable code for it. Check your own payer. He recommends the work either way, and he expects funders to require it in time.

Here is the argument he uses with owners and directors. Better outcomes keep families enrolled. A client who might leave at six months stays eighteen months and graduates. Happy families tell other families. Pediatricians send the next referral to the analyst who called them. In his experience, one strong partnership can bring five to eight referrals a year. It also means fewer early discharges and more school contracts.

He was candid about why the business section exists at all. As a clinic director and lead BCBA, he could not get plans approved without tying them to revenue. If you need buy-in for unbilled hours, bring the retention and referral picture with you.

The starting plan is small. Pick three collaboration partners across your caseload, the providers your families see most. Ask each caregiver for a three way introduction. Then build the system: a set rhythm, a shared outcome, and an agreed way to trade feedback. Add a few more meetings each month after that, and the habit builds itself.

better outcomes for clients pay off in spades even if these appointments are non-billable

From the talk — Matt Harrington