When considering ABA providers for your child, you may be feeling overwhelmed with the amount of available information. You want the best for your child and therefore you want to be sure that the provider you choose can provide quality care. You ask yourself (and Google): what is the best ABA therapy near me?
This all comes down to understanding what to advocate for and asking the right questions. Doing so will ensure the chosen providers are a good fit for your child’s needs.
What is ABA therapy?
First, it’s essential to have a strong understanding of what ABA therapy is and how it may help your child. Applied Behavior Analysis (ABA) is the application of behavioral principles such as reinforcement, chaining, and shaping. ABA therapy, while it has a wide range of applications, is commonly prescribed to children with autism. This is in part due to the scientific evidence backing ABA therapy as a medically necessary treatment for the symptoms of autism. While autism spectrum disorder is a lifelong condition, ABA therapy can significantly improve the quality of life by teaching crucial life skills.
ABA therapy can be used to teach communication skills from simple requests to ongoing conversations. ABA therapy can also address social skills such as understanding emotions, interacting with others, and understanding sarcasm and figurative language. Other areas addressed in ABA therapy include adaptive living skills, self-advocacy, and more. Many children develop improved communication through ABA services, whether via spoken words, pictures, signs, or another mode of communication.
ABA therapy is individualized to each child’s unique strengths and needs. Therapists often use the child’s motivations to teach new skills in a fun and engaging format.
How many ABA therapists will work with my child?
Your child will typically have a team of therapists supporting their needs. A Board Certified Behavior Analyst (BCBA) will conduct assessments, create programming, train and supervise technicians, and perform ongoing analysis of progress. BCBAs also meet with parents and caregivers to train them on ABA therapy techniques to generalize goals from the therapists to the caregivers. In addition to the BCBA, your child will have one or more behavior technicians (BTs) or registered behavior technicians (RBTs). Depending on the provider, your child may also have a mid-level provider who assists the BCBA with program development and supervision.
The number of BTs on your child’s case will depend on how many hours your child is prescribed. Children receiving a more intensive level of hours will likely have two to four BTs. This will also vary depending on the company’s scheduling policies.
Generalization, or the ability to demonstrate skills with multiple people, in multiple settings, and with multiple stimuli, is an important aspect of ABA therapy. Therefore, having multiple ABA therapists has its benefits. However, having too many therapists may be a red flag. It’s best to strike a good balance of two to four.
Questions to ask ABA Therapy Services
The demand for ABA services has significantly increased over the last several years, likely due to improved autism awareness and diagnostic techniques increasing the rates of autism spectrum disorder and the number of autistic children. According to the BACB, the demand for Board Certified Behavior Analysts has increased 5,852% across the last 12 years. As this need has increased, so too have the agencies available to provide ABA therapy. Not all are created equal, however. Each person’s needs are individual, and therefore some agencies may be a better fit than others for your child’s needs.
Knowing the right questions to ask can make all the difference when seeking ABA therapy companies. Everyone’s goals and expectations for therapy are different. Consider the following questions and identify which aspects are important for your family. Any areas of importance should be discussed prior to therapy initiation, to avoid surprises later down the road.
What are your staffing processes?
You will want to go into ABA therapy with a thorough understanding of what the staffing situation is like in the agency.
● Are therapists currently available or will there be a “ramp-up” period? Some ABA providers will begin therapy for a child, only when they have secured behavior technicians. Others may start with the BCBA providing services only, as they hire and train new technicians. It is beneficial to have clear expectations of how long until your child will be receiving their full number of prescribed hours.
● What is your turnover rate? Turnover is, unfortunately, inevitable. Some therapists your child works with may be there long-term. For others, this may be a shorter-term position. However, choosing the right ABA services includes considering how significant turnover might be in their agency. Steer clear of ABA services who cannot provide information on turnover, those who have significantly high rates of turnover, and/or those who don’t have action plans for addressing and reducing turnover.
● Do you have floater positions? What is the process when someone calls in? Everyone gets sick or experiences emergencies from time to time. However, it’s important to ensure continuity of care. Therefore, you may want to ask what a company’s procedure is for calling in. Some companies may have a floater position, who can fill in when sessions are canceled. You may also want to ask about company expectations for attendance.
● What are the training processes like for new technicians? You may want to ensure that a provider has a solid onboarding and training process. Don’t be afraid to ask what these procedures look like. If minimal training is provided, that may be a red flag.
What are your safety policies?
Your child’s safety is crucial and should be of utmost importance for a provider. Consider the following questions to identify whether a provider you are considering will ensure your child’s safety.
● Can I observe sessions? An ability to observe sessions can improve confidence in an agency and the ABA therapist you are entrusting your child with. If it is an in-home provider, you should be allowed and encouraged to observe sessions, so long as your child can attend with you being present. If your child works better without you present, ask if the company would allow you to have a nanny cam in the room they are working in. If your child will be attending in a clinic setting, observation may not be allowed due to privacy requirements, though it is worth asking.
● What safety or crisis policies do you have in place? If your child is a wanderer or exhibits potentially dangerous behavior, you may want to ask what procedures are in place to ensure their safety. Also, consider whether the company prioritizes addressing safety goals.
What goals would you be working on with my child?
The primary answer should be whatever goals are important to you and your child. However, there are additional considerations regarding the way a provider approaches goal planning.
● How do you determine what goals to address? You may want to have a good understanding of what factors are considered when determining goals to work on with your child. Some considerations may include goals based on assessments, observations, caregiver input, and child input. Again, goals should always be individualized. “Cookie-cutter” style programs should be actively avoided.
● Do you target stimming behavior? In the past, self-stimulatory behavior, also known as stimming, was commonly targeted for reduction in ABA therapy programs. Some examples include spinning, arm flapping, and finger flicking. Stimming often serves an important purpose including self-regulation and comfort for your child, making this an important consideration when choosing a provider.
● Do you focus on assent and acknowledge assent withdrawal? As a minor, children are unable to consent to treatment, and therefore, parents provide the consent. However, assent is just as important. Assent is the verbal and non-verbal behavior indicating approval. Within ABA therapy, assent might be presented by verbal agreements, or non-verbal behaviors such as smiling, laughing, and approaching the ABA therapist. Assent withdrawal may occur by your child screaming, running away, or refusing to follow through on instructions. Therapy should be enjoyable for all parties and should be based on improving a child’s quality of life, not solely teaching compliance. Teaching our children that their efforts to self-advocate are acknowledged is important as well.
● Are goals addressed in a structured setting or within play? There are many ways to provide ABA therapy. This should be individualized to what is most beneficial to your child. Some children thrive in a structured environment with a school-like setup, working at a table with a scheduled plan. Others do better within a play-based setting, with goals conducted in their natural environment. It’s not as much a matter of which is better than the other, but rather which is best for your child.
● How often are goals assessed? You may want to know how often new goals are created and how frequently reassessments occur. What does the reassessment process consist of?
In what ways are parents involved?
Parents and caregivers should be involved in their child’s ABA therapy. Caregiver participation may improve outcomes and generalization of skills.
● In what ways will I be involved in therapy? It’s best for everyone to establish guidelines for involvement in sessions, especially for in-home therapy. You’ll want to ensure that the provider’s expectations match your availability during sessions.
● How often is treatment guidance or training provided? Treatment guidance is essentially training caregivers on ABA therapy principles and techniques so that they can continue implementing strategies when the ABA therapists are not present. This carry-over from therapy to home life is important. If a child can demonstrate a skill in a treatment setting, but cannot reliably demonstrate the same skill in their natural environment (at home with their parents), then the skill taught has not served its purpose. Ongoing treatment guidance should be a primary focus of therapy. It should also occur at a frequency that works within your availability.
● How do I monitor progress? Do your ABA therapists provide a session summary at the end of sessions? Are daily session notes and data readily available to review? These are all important questions to consider, if monitoring ongoing progress is important to you.
What type of collaboration can I expect?
Your child may be receiving ABA therapy exclusively, or in combination with other therapies and/or an educational program. Effective collaboration across teams can greatly improve a child’s progress.
● Do you collaborate with other professionals? If a provider is unwilling or unable to collaborate with other professionals your child works with, this may be a red flag. There are many benefits to collaboration.
● What does collaboration look like? How often? Consider what the provider emphasizes in collaboration and how it could be of benefit to your child.
How are transitions and discharges determined?
Sometimes when first beginning ABA therapy, it’s difficult to even think about one day discharging. However, at some point, your child will likely begin transitioning and eventually discharge from treatment.
● What criteria do you set for transitioning? Transitioning typically indicates a titration of hours from a higher intensity to a lower one. If your child starts therapy receiving 30 hours/week, when can you expect that number to reduce? As always, this should be individualized, though individual criteria should be set to help gauge when this reduction will occur.
● What criteria do you set for discharge? Discharge indicates the discontinuation of therapy. This is important to know, so you are not thrown off by any surprises. For example, if an agency has criteria for discharging clients when they reach a certain age, perhaps 7 years old, this would be vital to know and prepare for.
Ethical considerations in Applied Behavior Analysis
ABA therapists are bound to ethical requirements laid out by the Behavior Analyst Certification Board (BACB). While these guidelines aim to ensure that the well-being of our clients is of the highest priority, as in any industry, there may be some “bad apples.” Don’t be afraid to question practices that appear potentially harmful and/or unethical. For example, ABA therapists are required to exhaust all reinforcement-based strategies before using punishment-based strategies such as response cost or overcorrection. Therefore, a provider should be rarely using strategies that are not based on reinforcement. If a provider indicates punishment procedures are regularly used, this may be a red flag of ethical concerns.
As a parent, you are your child’s #1 advocate. It is important to thoroughly vet ABA therapy companies before proceeding with treatment plans. Identify what is most important to you and your child and don’t hesitate to ask questions.