Marcus didn’t quite meet the milestones that the doctors had predicted for a four-year-old. After some testing and evaluations with his pediatrician, the doctor concluded that Marcus had an autism spectrum disorder (ASD), and he told Sarah and her husband that Applied Behavior Analysis (ABA) could be a good option for their son. Before the process had even begun, Sarah had dozens of questions like: What is ABA?” How am I supposed to find a good provider for my child? What is the ABA process going to look like for my son and our family?
Understanding the Initial Assessment Phase
The first step in the process to develop a Behavior Intervention Plan is to have the child undergo an assessment by a Board Certified Behavior Analyst (BCBA). This is not a brief or simple process; the assessment is spread out over several weeks and typically includes several sessions. The BCBA will have several interviews with the child and his/her family members, conduct observations of the child in several settings, and talk to teachers, caregivers, babysitters, etc. that have contact with the child.
In conducting the assessment, the analyst will document the child’s emerging skills in the areas of communication, social skills, daily living skills, and academic skills. Additionally, the analyst will document specific targeted behaviors that may be interfering with learning interactions or developmental progress. The analyst will gather information on the child’s emerging skills through direct interaction with the child, the use of standardized assessment tools, as well as an in-depth interview with the child’s caregivers and/or parents.
Our evaluation process is different from most child assessments. Most child assessments provide an overview of a child’s current status or behavior (e.g., having a temper tantrum). At PCP, our assessment process goes a step further by describing the child’s behavior in terms of their function. What does the child get out of having a tantrum? What purpose does this behavior serve for the child?
Developing an Individualized Treatment Plan
Once the assessment has been completed, the BCBA will then create a treatment plan for the child. The treatment plan will outline goals for the child as well as target behaviors that the child exhibits, which therapists will work to increase or decrease in order to best meet the child’s needs. The treatment plan serves as a guide to direct the child’s therapy session.
Many goals at the same time! In our last meeting with a family with a 2-year-old child with ASD, we mapped out a plan to support him to verbally communicate, tolerate changes to routine, and show flexibility within transitions. All goals are worded behaviorally and broken down into steps for the child to follow in order to achieve the goal, such as “After 3 minutes, student will request preferred items using two-word phrases (e.g., ‘want juice’) 8 out of 10 times.”
Finding the Right ABA Provider
Here’s where things get complicated.
There are several characteristics that families consider when selecting a provider of Applied Behavior Analysis (ABA) therapy for their child and family. Many are drawn to ABC ABA because of the presence of BCBAs on staff as well as the licensure and experience of our providers. We also serve families who value the resources and support of a larger organization as well as families who appreciate the personal touches of a smaller practice. Ultimately, the provider who best serves a child and family is a matter of personal preference.
At times, the state in which a child’s home is located can play a role in provider searching. For those families seeking ABA therapy in Boston, MA, there are numerous established providers to select from. Some have focused areas and philosophies, and it is very important to find a center and their values to be aligned with those of your family. Each ABA provider has the ability to address a child’s needs.
Don’t be shy to ask about the training and continuing education of the therapists, as well as the therapist to caseload ratio. You should also ask about how they handle rapid staff turnover in the selection process. A program may look good on paper, but nothing ruins a child’s experience quicker than inconsistent staffing.
Insurance Authorization and Logistics
Most insurance providers (employer-based and private pay) now consider ABA therapy for autism medically necessary for treatment. Processing through insurance can be slow and painful at times. However, we are lucky to say that we can usually handle this process for our families. Most of the time all we need is an updated comprehensive assessment and a current description of the child’s treatment plan. Each company processes differently at a different pace. Some authorizations are obtained within days, while others take a few weeks.
Some organizations have decided to automate 100% of recommended hours and others have decided to start with a lower number of hours and require periodic updates/pulls to incrementally add coverage.
In contrast to pondering the theoretical implications of “the right” therapy approach for your child, you’re probably more concerned with two practical issues: One, where will the therapy occur (your home or an out-of-home clinic)? Two, how will the therapy fit into your family’s busy routine and into your child’s school schedule? I have watched many well intended plans for the treatment of a child’s behavioral, emotional or learning difficulties fail for these very reasons.
Starting Active Treatment
In the first few months of therapy, we are building a relationship with your child. The therapist, typically a Registered Behavior Technician (RBT) with supervision by a Board Certified Behavior Analyst (BCBA), is getting to know your child’s personality, likes and dislikes and will identify your child’s strengths and how they communicate.
It’s been a bit of a slow burner the past week or so. But that’s because lots of groundwork has been laid along the way, and today’s story is starting to benefit from that.
We begin with simple goals and gradually increase the level of challenge as the child becomes more familiar and comfortable with the process. The BCBA observes, records and reviews data from each session and makes any necessary program adjustments based on the child’s response, learning rate and data. The data is collected in every session to see what is working well and what is not.
Ongoing Collaboration and Progress Monitoring
A quality ABA program includes the active participation of family members. In addition to weekly sessions with the Board Certified Behavior Analyst (BCBA), family members and siblings meet with the BCBA on a regular basis to learn strategies to generalize the techniques used in sessions to increase their effectiveness in real world situations in which the individual with autism faces challenges. Parents and siblings learn how to use these techniques to reinforce positive behaviors and address problems that occur outside of sessions.
We meet with you and your child once a month or every three months for a Progress Review meeting. This meeting is used to track your child and family’s growth and celebrate the successes. Goals are rewritten as needed to better support the child and family. Challenges and concerns are addressed.
Not all children follow a straight line of progress. Some children go from pulling their pants up at age 2 to using the toilet perfectly at age 3. Others may reach a plateau for several months. A few may start off slowly and then suddenly pick up speed. In order to remain useful to parents, this variability must be understood and accepted, for the fact is that toilet training is a long-term process, and parents must have realistic goals for their child’s progress.See More