Saturday, October 13, 2012

Selecting an ABA Provider







This is a continuation of my post about staffing your in-home ABA program, How to Hire ABA Therapists: The Interview. That post was for families who aren't using a company or the school system to get ABA services, and instead are hiring staff directly to work inside their home.

This post is intended to be helpful to families who are working with an agency/company that sends therapists out to your home. It can be difficult to know how to evaluate the quality of an ABA agency, what services they should provide, and what expectations to have.
There are some families who approach agencies demanding the absolute best, and this can be a set-up for disappointment. On the other hand there are families who place all of their trust with an agency and ask no questions, and that can lead to poor quality of services.


Similar to selecting and interviewing your own ABA therapists, parents have the right to be thorough and selective when choosing an ABA agency. Depending on the area you live in and the funding sources available, there can be a variety of agencies to choose from or only a few agencies available. 

Parents here is a tip: the parts of the country with the best funding sources tend to have the most agencies available. Places like CA, NY, CO, and FL are flooded with ABA agencies. Cities and states without insurance funding or other ABA resources tend to have only a few agencies to choose from. So if you only know of 1 or 2 agencies in your local area, it’s probably because there are limited funding sources. The good news is many ABA agencies provide long distance services, so don't feel hopeless if there are no quality agencies in your area.


Here are some tips for what to expect when starting services with an agency:

What To Expect-

  • Intake Process: The intake process is basically where the agency is gathering information about you (the parents) and your child. This can include a telephone interview, a home visit, and likely lots and lots of paperwork. The agency may also request various documents from you, such as medical reports, or the most recent IEP. During this time the agency may also explain any policies and rules they may have, and have you sign a contract.
  • Assessment/Observation: The goal of the assessment is to determine your child’s current level of functioning and learn about your child's motivation, interests, and problem behaviors. The assessor may obtain this information via observation, record review, parent interview, testing your child, or a combination of all of these methods.
  • Program Development aka “The Plan”: “The Plan” refers to the plan of action created for your child, based on the results of assessment. This plan of action can include instructional goals (e.g. language) as well as behavioral goals (e.g. reduce tantrumming). An agency representative, usually a Lead Therapist or Supervisor, will create multiple goals for your child and should explain all of the goals to you in a manner that is easily understandable to you. What I mean by that is the supervisor should not just hand you a program book and tell you to read it. The supervisor should answer any specific questions you may have in simple, plain language.
  • “The A- Team”:……And here comes the team. This is the point where you would typically meet your child’s new therapist(s). The supervisor will fade into the background somewhat, and the ABA therapists will be the ones who come to your home 2-5 times a week to work directly with your child. Usually agencies put 1-3 therapists on a case, and each person works 3-5 hours per week with your child. You should be given a schedule so you can know who will work on what day, at what time, and for how long. Do not feel that you have to just accept the people the agency sends to your home, because you don’t. However, it’s important to be realistic. If you keep rejecting the therapists the agency sends to your home, one of two things is happening: you are being too picky and the agency will soon be unable to find staff for your case, or the agency has very low quality staff members who leave much to be desired.
  • Parent Training: This is where that supervisor you met in the very beginning stages will begin coming around again. The supervisor was still involved the whole time, but sometimes they aren’t as visible as the ABA therapists. Supervisors have many behind the scenes duties such as writing programs and analyzing data. In addition to these duties, the supervisor should also incorporate parent training on a regular basis. Parent involvement is a critical key to the success of any ABA program, so if you have no idea what your child is learning in their ABA sessions, that is definitely a problem.
  • Meetings, Meetings, and Meetings: There should be some system in place for accountability and tracking progress. This usually happens with face to face meetings where the team (including you) may meet in or outside of the home to discuss in detail your child’s progress. If face to face meetings do not occur, then there should be a system of communication between you, the therapists, and the supervisor, such as emails, phone calls, written notes, etc. At a minimum, the ABA therapists should be taking time at the end of each session to update you on your child’s progress, any new behaviors, etc. The therapist should not just finish a therapy session and leave your home.

What To Look For-
  • Professionalism: It is a sad reality that there are agencies out there who care nothing about the science of ABA or helping people, and are simply looking to make $$. As a parent you might not be able to question an agency about complicated behavior analytic techniques, but you can look for evidence that you are dealing with professionals. If you give a developmental evaluation report to the agency in August, are you still waiting for them to give it back to you when October rolls around? If you call the supervisor assigned to your case and leave a voice-mail, does it take her 2 weeks to return your call? Do the ABA therapists consistently arrive to your home to do a therapy session wearing revealing, low cut clothing, or are they on their cell phone constantly during the therapy session? These are all indicators that you may be dealing with an unprofessional and likely unethical agency.
  • Respect: Do you feel valued and respected by the agency and its staff? Are your opinions and ideas about the goals and behavior plan listened to and viewed as valued input? Or does the staff make you feel as if they are the experts, you are the parent, and you should keep quiet?
  • Says “No” To You: Okay, let me explain this one. It is important that the agency and its staff sets boundaries, and boundaries mean that sometimes they will need to say no to you. I once worked for an agency that had a policy that they “never turned a client away”. That sounds very nice in theory, but in practice what it meant was that the staff was severely overworked and stressed because they were given far too much to do. Overworked staff will produce sloppy work, and stressed staff will quit. Instead, the agency should set clear boundaries and politely maintain those boundaries. If the company is always bending over backwards to please you, and setting rules and then allowing you to break them, you may be dealing with an unethical company that is more focused on profit than quality services. That kind of agency will do or say anything to keep you as a client, and to keep your money.
  • HAPPY Staff: It usually isn’t hard to tell when an agency mistreats its staff. The ABA therapists always seem to be irritated, tired, or stressed out when they arrive for therapy sessions. The owner or management doesn’t seem to care when staff leave or quit, and is very vague about the interview/selection process of new staff (that means there probably isn't a process).  Do the ABA therapists complain to you about a lack of training? Are they always making comments about how they "don’t get paid enough" to put up with your child? These are all signs of unhappy staff, and if several staff members are acting this way that’s a really bad sign.


**Quick Tips: 

-A handy checklist for parents giving tips on how to select a quality ABA provider. 

-Here is a wonderful blog post written by a parent that gives specific tips on how to select an ABA provider.

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