Learning from each other: The Iowa LEND and Puerto Rico UCEDD collaboration

February 8, 2019

Best practice in the assessment and treatment of challenging behavior for individuals with intellectual and developmental disabilities includes using applied behavior analysis (ABA), specifically implementing functional behavioral assessments and function-based treatments. These types of assessments and interventions are implemented typically by board certified behavior analysts (BCBA®) and by psychologists with training in this area. Currently in Puerto Rico, there is a lack of access to trained providers and local training programs in ABA. In 2015, the then Interdisciplinary Coordinator of the University of Iowa's LEND program, Suzanne Pearson, remembered a conversation she had with an ILEND trainee from Puerto Rico 5 years earlier about the lack of behavior analytic services in her island. That conversation spurred a collaboration between ILEND and the University of Puerto Rico's University Center for Excellence in Developmental Disabilities (UCEDD) to help bridge some of the gaps in Puerto Rico in ABA. The goals of the project are to:

  1. Develop leaders in Puerto Rico in behavior analysis and challenging behavior.
  2. Support the PRUCEDD in the creation of a BCBA course sequence within the University of Puerto Rico's Medical Sciences campus.
  3. Increase Iowa LEND trainees' cultural awareness and understanding of the strengths and challenges of serving individuals with IDD in Puerto Rico and the Latino population.

Yaniz Padilla Dalmau, PhD, BCBA-D who was an Iowa LEND trainee in 2011-2012 and is originally from Puerto Rico, serves as the liaison between the PRUCEDD and the Iowa LEND. Dr. Padilla Dalmau received training at the University of Iowa in both the assessment and intervention of challenging behavior and the delivery of these services via telemedicine. She provides a year-long training for Puerto Rico trainees and in coordination with the current interdisciplinary training coordinator for ILEND, Kelly Von Lehmden, she facilitates a one-week internship for the Puerto Rico trainees in Iowa. Carol Salas Pagan, PsyD, Director of the PRUCEDD and her team design, coordinate, and provided a one-week cultural immersion internship in Puerto Rico for the Iowa trainees and provide on-site support to the Puerto Rico trainees as needed. Throughout the year, the trainees have opportunities to present about their experiences to each other.

The Iowa LEND-PRUCEDD collaboration has been ongoing since 2016 despite experiencing significant hurdles in communication and priorities during 2017 when hurricane Maria hit Puerto Rico. To date, four Puerto Rican psychologist trainees have participated in the intensive, year-long remote training, and 11 Iowa trainees of various disciplines have visited Puerto Rico. Overall, all the stakeholders in this project have found the program an enriching experience.

The Puerto Rico trainees receive didactic training (e.g., webinars, assigned readings, teleconferences to review material) and live coaching through teleconsultation by Dr. Padilla Dalmau to implement the target skill with children who had intellectual or developmental disabilities in Puerto Rico. When they travel to Iowa, the trainees can observe various clinics at the Center for Disabilities and Development and the University of Iowa Stead Family Children's Hospital in which individuals with and without IDD who have challenging behavior are treated. The clinics include the biobehavioral service day treatment program, biobehavioral service outpatient program, adult outpatient program for challenging behavior, and autism clinic for challenging behavior. The Puerto Rico trainees have significantly increased their knowledge and implementation of important skills to evaluate challenging behavior including case review, descriptive assessment and preference assessments. In addition, the majority of the trainees are now interested in continuing to learn ABA and obtaining additional advanced training. Aimar Cajigas Altreche, PhD, one the Puerto Rico trainees, stated:

Being part of Iowa-PR LEND, was an enrichment experience. As a school psychologist, from the beginning of my professional career, I have always been interested in Applied Behavior Analysis. This experience was one of much learning. I learned to identify and define problem behavior and what is causing this behavior. The visit to the clinics in the University of Iowa taught me how to be in a scenario where the behavior can be observed, treated and modified. I want to thank all the specialists that welcomed me and made this visit so special. I came back to Puerto Rico with more desire to work and help children with behavior problems, knowing that the Applied Behavior Analysis can change and modify behaviors, helping kids and their families have a better quality of life. I recommend this project to other students interested in behavior. A project that I know Dr. Padilla and all the specialists and staff of the LEND in Iowa promote and work with love for people in Puerto Rico. I hope I can obtain my BCBA certificate in the not so distant future. Thanks to all the Iowa-PR LEND for this experience, that in part changed my vision about children with problem behaviors.

The most recent milestone for this project was the cultural immersion internship week in Puerto Rico. The Iowa trainees experienced a  week-long cultural immersion experience which started with a 2 hour panel of stakeholders in the area of IDD in Puerto Rico (parents, advocates, special education teachers, expert psychologist, behavior analyst, Special Olympics coach), and continued with case studies in the area of Autism by Puerto Rican experts, a visit to the Graduate School of Public Health where the PRUCEDD is housed, a presentation by the parent advocacy group The Alliance of Autism, a visit and presentation by the Department of Education's Special Education Program, visits and presentations by various Puerto Rico Department of Health programs (Program of Adults with Intellectual Disability, Advancing Together Part C and Auditory Screening), a visit to a state of the art local nonprofit (SER of Puerto Rico), a visit and presentation of the UPR Medical Sciences Campus Pediatric Hospital, and a visit to the UCEDD's child development center. The Iowa trainees were highly engaged during the internship and were left with newfound knowledge about the strength of the Puerto Rican spirit amidst some insurmountable obstacles to access services for individuals with IDD. One Iowa trainee, Elizabeth Bryant stated:

This experience in Puerto Rico is one that is immeasurable as a future provider as it is so critical to continuously expand my knowledge of the challenges and obstacles that are faced within other cultures. This project has allowed me to witness first-hand the tremendous efforts that the individuals and organizations we had the pleasure to meet with have put into making services for individuals with disabilities in Puerto Rico what they are today. I am still awestruck by the many obstacles that have been thrown in their way that they continue to overcome. This enriching experience has truly shown me how important it is a future social worker, or any type of provider, to advocate for client and cultural populations who have historically been underrepresented.  

Giannina López-Pérez, Psy.D.  trainee from Puerto Rico shares:

Doing the LEND collaboration with Iowa and Dr. Padilla this year has been a great learning and growth experience. It has greatly expanded my knowledge as a clinical psychologist and the importance of assessing the functions of behaviors to modify them. Knowing and collaborating with other trainees from Iowa in Puerto Rico was an excellent experience as we exchanged perspectives from each of the disciplines and had the opportunity to show them the services available in Puerto Rico for people with intellectual and developmental disabilities. I am looking forward to continuing expanding my knowledge in ABA and to be able to help so many people and families that need this specialized service. It has been a very rewarding and enriching experience and I feel fortunate to have been able to participate in this LEND program. I hope this collaboration continues and many more professionals receive training in what Applied Behavior Analysis is. Thank you!

Another Iowa LEND trainee, Shamira Rothmire shared:

The cultural immersion trip to Puerto Rico was one of my most memorable graduate school experiences thus far. Puerto Rico is a beautiful place, rich with cultural pride. Despite resource challenges and growing edges in service-delivery, the disability movement in Puerto Rico is thriving. I left more cognizant regarding the power of leadership and advocacy. Notably, many of the leaders within the disability movement in Puerto Rico are women. While laws are set to regulate procedures or behaviors for a country or community, these mandates are not always enforced and highlighted without committed leaders of integrity and passionate advocates. The same is applicable when disparities manifest. The progress that has been made over the years could not have occurred without those vested individuals. Puerto Rico's collectivistic commitment to improving the quality of life of people with disabilities is heavily informed by their rich culture. A group which comprised of diverse and enthusiastic professionals, families, and community members. As future leaders in our respective fields, I hope we will always remember the power of culture, leadership, advocacy, because we all will have an opportunity to make an impact. I am grateful for the opportunity because I left feeling inspired and more empowered in my ability as a leader.

As we prepare for the end of the third year of collaboration and prepare for our fourth, both the Iowa LEND and PRUCEDD teams remain committed to continue learning from each other by supporting the development of leaders in Puerto Rico and Iowa.