Operant Innovations 019 | Real World Example of Dissemination | Tiki Fiol

Shauna Costello (00:02):

You're listening to Operant Innovations. A podcast brought to you by ABA Technologies. As we begin 2021, we want to ensure that we're moving forward with intention. One way to do this is by reviewing the mission statement of ABA Technologies: disseminate the science and technology of behavior analysis worldwide through education, training, consultation, and product development. But we acknowledge we're not the only ones working on this or a similar mission. Recently, Tiki Fiol, President of the association for behavior analysis of Brevard, President elect of the Florida association for behavior analysis and President and owner of Tiki Inc. had the opportunity to speak with a local radio station to disseminate the science of behavior. Thank you, Tiki for your continued work and dedication to our science and our field.

Seeta Begui (00:54):

And now we have Tiki Fiol. Tiki is a lifelong resident of Brevard County, Florida. She was born right here in Melbourne. Boy, you were born when the hospital was still called Brevard Regional.

Tiki Fiol (01:05):

Correct.

Seeta Begui (01:06):

And raised in the Eau Gallie area. And I'm going to let you tell our listeners a little bit about yourself.

Tiki Fiol (01:12):

So yes. I was born in Brevard County back when it was not Holmes Regional. Grew up in Eau Gallie. Went to Our Lady of Lords. I'm the first generation born of Cuban immigrants. We were raised very Catholic. So I went to Our Lady of Lords for kindergarten through eighth grade and then Melbourne Central Catholic. I then graduated with a psychology degree from University of Central Florida and a Master's degree from Florida Institute of Technology in applied behavior analysis.

Seeta Begui (01:43):

And right now that's quite a mouthful. And so right now you're the current president of the association for behavior analysis of Brevard.

Tiki Fiol (01:51):

Correct.

Seeta Begui (01:52):

So tell us exactly what is ABA. I like the way it sounds. ABA. Ellen and I met at ABWA. Yeah. So ABA.

Tiki Fiol (02:01):

You want to know about the association or behavior analysis in general?

Seeta Begui (02:05):

Tell us about the association and then we'll talk about the analysis.

Tiki Fiol (02:10):

Okay. So ABA or the association for behavior analysis at Brevard is a sub chapter of the Florida association for behavior analysis. We work on the dissemination of behavior analysis through education, parent training. We also do volunteer work. We provide continuing education to behavior analysts that can maintain their certification at various levels. It's a lot of community outreach, socialization. So our behavior analysts that work across different environments do have an organization. A common tie that binds.

Seeta Begui (02:44):

We all talk about behaviors, right? And I, for one, have always believed that if you want to change our world, you change your behaviors and the environment in which we live.

Tiki Fiol (02:56):

Correct.

New Speaker (02:57):

So can you expand on that? Because a lot of people want to change their behaviors, but it really cannot be done unless you change the environment.

Tiki Fiol (03:05):

Right. So as a behavior analyst, we're looking at the science. We want to improve the human condition through behavior change procedures. We generally are trying to teach individuals or their families. You have to rearrange the environment, how an individual... Let's say someone has a very disruptive, dangerous or challenging behavior. It could be unsafe. It could be illegal. How do we change that? So as a behavior analyst, we come in and try to determine what the function or the reason for the behavior is. So if we determine the function or the reason what's the opposite side of that coin? If someone's engaging aggressions, because they want to eat lunch. Why would we not then teach them? If we understand the function, this is how we make lunch. This is how we get lunch. This is how we can get someone else's attention to help provide us with that food. So we look at behaviors almost as a way to communicate. There's a function. There's a reason. How do we teach this individual or more so, their families, their teachers, their circle of support. How do we rearrange that environment? So the behaviors that we want to see more often occur and pay those off. It's about efficiency and effectiveness. If it's quicker for me to get lunch, by stealing it versus waiting, making, having to find someone, having to open, maybe a very difficult jar to open, it's easier for me to snag it, eat it, and be done with it. Then it is as, as the other people that are more in control of the environment. If we can ease those other variables, that individual can engage in behaviors that are more safe, that are more socially appropriate. That still gets their wants and needs met.

Seeta Begui (04:45):

That they don't have to work as hard for.

Tiki Fiol (04:48):

Exactly.

Seeta Begui (04:48):

Exactly what David was talking about earlier.

Tiki Fiol (04:49):

Yes.

Seeta Begui (04:49):

That's why I said you two are a good fit for the show today. So how can our listeners learn more about ABA and how it may benefit themselves or their families? If someone that they know is having a behavioral issue right now?

Tiki Fiol (05:02):

So the first thing I would suggest is to learn more about ABA is to go to our board certification systems, to learn more about it. That is the behavior analyst certification board: bacb.com. Once there, you can learn more about ABA, the training that's required, the levels of certification, how long it takes for someone to get their education, to get their hours, to be able to sit for the certification exam, which is a very, very difficult procedure. They can also get additional information here in Florida at the Florida association for behavior analysis, which is FABAworld.org. And locally again is the ABAB group on Facebook.

Seeta Begui (05:45):

So people have weird behaviors, right? And we have seen.. We're watching people right now in our world who are about power and control. They're also about being a bully. They're also about spreading lies, hate, division. So are all these things, part of behavior?

Tiki Fiol (06:07):

Ellen made a very interesting comment at the beginning of the show. She had noticed on her social media feeds that people are behaving a little better. I want to back it up one step. So anything a person says or does is behavior. So we're always behaving whether it's on social media, whether it's you and I sitting next to each other talking, driving our cars, waking up with the alarm, taking a sip of water. Technically, that's all behaviors. What we want to kind of discern when we break this down at smaller or more, let's say molecular levels are, is the behavior socially appropriate or is it socially inappropriate? So is it safe or is it unsafe? Is it illegal or legal? So when we look at behavior, we want to be very specific. We say, "Oh, they're behaving this way." Well, what exactly do you mean? In what instance are we talking about the social significance of that behavior? What direction are we going in this conversation? And then we bring it back to function. What's the function? What's the reason? David had some interesting points. He had talked about how someone had tasted something bitter and then it made them sick. So they avoid something bitter in the future. So for, as behavior analysts, we would think they tasted maybe a novel stimulus. It made them ill. It made them sick. Through that pairing, they then generalize. They generalize this stimulus that used to be novel is now averse. It's dangerous. So I have to avoid that. In that very, very small instance or that example, let's take that to a bigger level. I have had a run in with an individual or I have had a run it like with a car. I've had a very bad car wreck. The car was red. I may then be scared of red vehicles.

Seeta Begui (07:55):

It was a very bad car accident.

Tiki Fiol (07:56):

It just stays in your brain until we then..

Seeta Begui (07:59):

It's lodged.

Tiki Fiol (08:00):

But then here's the important part. As a behaviorist, how do we unpair that? So we can present other stimuli without an aversive event happening. Right? Have you ever heard of someone who's afraid of spiders?

Seeta Begui (08:16):

Frogs. Frogs.

Tiki Fiol (08:17):

Okay. So we may present things in very small ways and show you that the frog didn't hurt you. The snake didn't hurt. We may start with pictures. Then we may go to a plastic animal or a frog in a jar. And eventually the frog is out until it's been presented so many times that there's no aversive event. It's not going to hurt you.

Seeta Begui (08:36):

So you teach them not to be afraid of that.

Tiki Fiol (08:38):

In essence. Yes.

Seeta Begui (08:40):

But you know our show is fun and it's very unscripted, right? And we try to educate people, but think about when you're small, right? You're a small child and your parents take you to a store or they take you to a wedding. I'm speaking like from the Indian people, right? You'll say, "well, before we leave the house.." You have that talk with the parents, right? And they say, "Now do not let me down. Be on your best behavior." And to us children, that meant don't run, don't jump, don't run around the people's house. Don't talk loud, don't get involved in big people's conversation. And then your parents reward you if you went and your behavior was up to mark. So then are they then teaching you at that point in your life, the value of behavior?

Tiki Fiol (09:29):

So in that example you gave: be on your best behavior. You did much better than most people would say. You specified what the parent wanted. Don't run, don't yell, use an inside voice. Then when you say we reward the person. What you want to do is re reward the behaviors you want to see, right? So when they are using an inside voice, praise them specifically for the inside voice.

Seeta Begui (09:53):

Right.

Tiki Fiol (09:54):

How then does an individual know, "Oh, that's the thing that gets me mom's attention." If the kid actually mows the lawn the way they wanted, and they really like $10, you give them the $10 right away. It has to be very close. You want to do what we call reinforce or increase that behavior in the future. So if we are attending more, in all of our lives, if we are attending more to the behaviors we want to see more of. If we want to see our neighbor engage in appropriate conversation with us. When they're in those appropriate conversations, we want to give them whatever we think that they really like. Attention. Come by and drop off some... if they really liked a certain food, bring it by and say, hi, and I had a really good conversation with you. Let's follow that up another day.

Seeta Begui (10:36):

Right.

Tiki Fiol (10:36):

What do you want to see more of? That's what you pay off.

Seeta Begui (10:39):

Right? So that's the reward.

Tiki Fiol (10:39):

Correct.

Seeta Begui (10:41):

So tell our listeners, on Viewpoint with Seeta and Friends, how does ABA work and describe the different locations, ages, approaches, et cetera?

Tiki Fiol (10:51):

So in ABA, we are the applied scientists, we're the applied practitioners. So typically a family let's say of a child or a young adult, or even an adult. Let's say we get a referral. A four-year-old child just recently diagnosed on the spectrum and there are some concerns that they have. They would contact their local agency or their local ABA provider. They would get whatever information is required by the insurance. Each insurance changes. Once all of that is set up, the behavior analyst goes to their home, or they would bring their child to a clinic or a school. They do what's called a functional behavior assessment. UAnd they have some questions. They might be running probes. They might be running some very specific tests. They want to find out what's the behaviors of concern. What are the deficits? So remember what we talked about before? Let's talk function. So if someone has a behavior, that's very... Let's say headbanging. They're hitting their head. They're hurting themselves. That's social significance, right? That's dangerous. That individual could hurt themselves. It's very difficult for parents to see that. So we look at what's the function of the behavior? Why are they banging their head? So we come up with our hypothesis. If we understand the function, hopefully then we come up with, what do we want them to do instead to get their wants and needs met? We develop a plan. The biggest part here is yes, we work directly with that child, but we teach the family members. If everybody implements this correctly and we reinforce or strengthen the behaviors, we want to see more often, naturally the headbanging or whatever are dangerous or challenging behaviors, it's going to fall off because they get their wants and needs met through the appropriate behaviors that we have.

Seeta Begui (12:31):

You have a care plan.

Tiki Fiol (12:32):

That's exactly it. So the care plan is implemented. We train the family.

Seeta Begui (12:36):

It's goal-oriented.

Tiki Fiol (12:38):

And our job... And this is whenever I open a new case, parents laugh at me, but my job is to get myself fired. I want to be fired because that means that family or that foster care, the parents can do it without me. And that means I get to go work with the next family down the street.

Seeta Begui (12:54):

Right. It sounds like you're an extension of the parents' arms. You're helping them, right?

Tiki Fiol (13:01):

Yes.

New Speaker (13:01):

So does insurance cover this? Because I remember that was how you and I met. We were talking on Facebook about, "does Medicaid cover this or private insurance?"

Tiki Fiol (13:09):

Each insurance.. What I would tell a family member that is looking that has these needs is check with your insurance provider. Some have very specific rules. Medicaid does cover this, and it covers it for many diagnoses, not just individuals on the autism spectrum. There is a procedure that has to be done with Medicaid. You would need to have, what's called a comprehensive, diagnostic evaluation that's completed by a licensed individual. So you would get the diagnosis. If the diagnosis is appropriate for behavior analysis, then the physician would order. They would request that information, it's sent to whatever provider you choose and then that process of going and doing the functional assessment, coming up with that behavior program training, and then getting ourselves fired. That's the rest of that progression.

Seeta Begui (13:53):

It's awesome. Do you have any friends in Tallahassee that's trying to legislatively help?

Tiki Fiol (13:57):

So, I am the president elect of the Florida association for behavior analysis.

Seeta Begui (14:02):

Pleased to meet you, my dear.

Tiki Fiol (14:06):

We are working, legislatively, through our political action committee to continue to not only disseminate behavior analysis, but to ensure that we're moving forward. So all individuals can access it. Recently we did have some success in last year's legislative session that we passed HP731, which was signed by governor DeSantis. It provided an exemption for behavior analysts. The agency for healthcare administration had a requirement for licensure. Behavior analysis is not a licensed service provision under ACCA at this time, although we would love it because then we have some different things we can do. Our practice was then not going to be able to continue unless we had licensure or someone that had no training in ABA oversee us. So that was pretty difficult. So we were lucky with that. Governor DeSantis did sign that. The next piece of big legislation we're looking at is registered behavior technicians. They are kind of like our frontline workers, right? They are a registered individual that goes in and does the bulk or the majority of the work with the individuals that we work for and the families that we see. Currently, our Florida statutes, do not allow for registered behavior technicians to go work within our public schools. So years ago, Florida statutes 490 and 491 and 393.17. We do have a definition of applied behavior analysis in our statutes. We do have the governing board, which is the BACB, which I discussed earlier. There was no such thing as a registered behavior technician when ABA was included in the law. So the spirit of the law and the letter of the law have grown, or the spirit of the law has not grown as well as the letter of the law has. We are really trying to push that the RBTs be allowed to provide this medically necessary service in whatever environment the child needs. And if that's within a school that they can assist.

Seeta Begui (16:12):

Then why not?

Tiki Fiol (16:12):

Then why not. We were successful here in Brevard County. We went to several school board meetings and they did overturn their ban.

Seeta Begui (16:20):

Yeah.

Tiki Fiol (16:20):

So we have been working. Last year we were within one vote. We missed it by one vote. So we're going to try it again.

Seeta Begui (16:28):

And well, before we go.. segments go so quickly. Oh gosh. Such interesting conversations. COVID-19. It's challenging as a nurse. It's challenging as a human. How challenging is it for you all to try to help people with behavior right now?

Tiki Fiol (16:44):

it is very difficult. Many providers have come up with different or unique ways to do it. If you're in a school, then you're going to follow some different guidelines versus if your practice leads you into their home or into their community. We follow a lot of the same medical guidelines. Taking temperatures, asking the same questions. We may shift so you have less individuals with your home for less exposure. We also are pushing, legislatively, or working with the agency for healthcare administration to come up with telehealth. How can we use telehealth if it's not safe to go into the home, but the family is benefiting or needs these services? Because behavior analysts aren't licensed. Only licensed individuals can provide telehealth. So again, there's that catch 22, but ACCA has been very good at working with FABA to come up with some plans during this COVID-19 crisis.

Seeta Begui (17:39):

Right. You also were a witness in a Medicaid fraud case.

Tiki Fiol (17:46):

Yes.

New Speaker (17:46):

Thank you. Our tax payers appreciate people like you.

Tiki Fiol (17:50):

Absolutely. I am a contracted ABA expert witness working with the state attorney's office so that when there are arrests we can review the files. And then the state would decide if they're going to proceed with criminal charges or how that would go going to court. Now I will add here again, if we were licensed, the department of health could serve someone and they would cease being able to provide services.

New Speaker (18:18):

Gotcha.

Tiki Fiol (18:18):

Just like if someone was a licensed mental health counselor, just like someone's a licensed nurse. If someone is licensed, the department of health can serve them and it stops. Currently, our certification board and lack of licensure, we're stuck until someone is actually found guilty.

Speaker 3 (18:34):

I see. Wow. We learn so much on Viewpoint with Seeta and Friends, Ellen.

Ellen (18:37):

It's amazing.

New Speaker (18:37):

So when you have free time, Ms. Tiki Fiol, you volunteer with the surfers for action.

Tiki Fiol (18:44):

Surfers for autism.

Seeta Begui (18:46):

For autism. Paul, how much time do we have?

Paul (18:48):

4 Minutes.

Seeta Begui (18:48):

Oh, good, good. I want to hear a little bit about surfers for autism.

Tiki Fiol (18:52):

They're a nonprofit organization. I think this year they couldn't do it obviously because of COVID. But I believe it's 11 years now, they've been running. They go all over the state and sometimes parts of Georgia. And it's just a group of surfers that come together and have individuals on the spectrum, teach them how to surf. They bring them out on a board where there's a lot of us that are volunteers. We assist them. I have seen kids that were what we would call non-verbal. So they don't use spoken words to communicate, start saying words right after a session. Families love it. It's a good way to get the community to come together. There's other community providers, maybe speech and OT, physical therapy. There's a lot of other providers that come together and it does allow for another option to have a kid in their family or young adult in their family, learn some different skills, learn some different activities that they can then take home and do as a family.

Seeta Begui (19:49):

Yeah.

Tiki Fiol (19:49):

I mean, in Brevard County, we got 72 miles of beach. Wouldn't you be able to love to take your kid out and have a new skill set and something different to do? And there's lots of organizations in our county that are working on these types of things and throughout our state.

Seeta Begui (20:02):

Right. So I know we still have like a minute left. So I want to ask you a question. We talked a little bit. Two minutes. This word inclusion. I have found that when you include people in anything you're doing and you stop the bullying, it makes a better society. Talk to our listening audience on Viewpoint with Seeta and Friends here on WWBC. I should say our dial sometime. AM 1510 FM 94.7, 99.9 and a 100.7. That word inclusion. Speak to that word for us. Tell our audience how you feel about that word inclusion.

Tiki Fiol (20:37):

So in what I do every day in life, we work with some individuals that maybe are not able to fully participate in their community and in their school. Maybe in their church. If we can teach better skills for families, if we can teach better skills in our community, if we can teach better acceptance, some better understanding. If an individual can become a bigger and broader and more important part of their community, they give back just as much as the person that has lots of money and lots of abilities.

Ellen (21:06):

Yeah.

Tiki Fiol (21:06):

There's lots of different ways. We can bring everyone together and allow them to participate and be part of our community and be one of our neighbors. Just like everyone else. Just because someone has a different diagnosis or a different ability, or even a different way they look, sound talk or not. A different way they ambulate or their mobility. They should still be able to participate. They should still fully be able to provide and give back to the community just as much.

Seeta Begui (21:35):

Right. So what I'm hearing is that you're saying that we all need to be educated on these things.

Tiki Fiol (21:40):

Agreed. Absolutely.

Seeta Begui (21:40):

So it always comes down to uneducation.

Tiki Fiol (21:43):

Yes.

Seeta Begui (21:43):

When you educate people, you can have a society that's flourishing where everyone gets a seat at the table. And I'd like to bring you back one day, because I want to do a show about the importance of a kitchen table. Why is it so important if you don't have a kitchen table? Maybe you just have a stool. Like we did. My father just built something makeshift, but conversations around a kitchen table with a family can include not just your family members, but the entire world. Because when you talk at the kitchen table, you're talking about things that are going on around the nation, in your home, in your community, right? So give us a website one more time for your business or both of the businesses. You're sponsoring today's show for?

Tiki Fiol (22:26):

My business is sponsoring this.

Seeta Begui (22:28):

Right.

Tiki Fiol (22:28):

So my company webpage is behaviorcounts.com for our private side, but Florida association for behavior analysis is fabaworld.org.

Ellen (22:39):

And we've put all of that on our Facebook page. And once again, Seeta, thank you so much for another fantastic week of Viewpoint with Seeta and Friends. These fantastic guests. Thank you so much, David Jones and Tiki Fiol. Got it. Have a wonderful week folks. We'll see you next Monday.

Shauna Costello (22:56):

Thank you for listening to this episode of Operant Innovations. If you know of anybody else showing exemplary examples of dissemination of our science, please feel free to reach out to us at operantinnovations@tabatechnologies.com to have them featured on our podcast.