Tuesday, November 4, 2014

Its So Hard to Say Goodbye





Ahhhhh, how to say goodbye to a client/family that you have painstakingly and diligently been working with for months, or often for years………


Transitioning a client out of services is not something that is talked about much, which is odd to me. It seems like there may be some uneasiness around talking about this topic. The reality is, most ABA professionals only serve a client for  a few years or less. At some point we all experience a client transition process, which is a really nice word for termination of services. 

ABA therapy in most scenarios begins when the client is  young... between 3-6. In most scenarios, the treatment starts out being very intensive, and then once the client starts  school services fade to after school hours only. Over the next 1-3 years it usually becomes clear if the client will soon be fading out of services or if they will need some level of life long support. I am choosing my words carefully here, because all situations and cases are different.

 That school age client may go on to receive ABA into adolescence, and then into their teen years.  Therapy does not have to cease just because the client ages (although many professionals or agencies only serve younger clients). In some situations ABA services continue right up into adulthood, and the ABA team helps the individual find employment, make friends at their group home, or learn self-care skills like shaving.

While this lovely, rosy outcome can occur, where a client is at the same company from the time they start services to the time they stop services, its not super likely. What is more common is that people move, staff quit, the family loses funding, etc.  In other words, termination of services is often due to some life event.


When planning for a termination of services, this is a conversation that needs to happen much sooner than most people think. I usually talk about termination during the intake process. During the intake process, its helpful to explain to the family what the criteria is around transitioning, what happens during transitioning, and how they will be notified when nearing discharge.  It’s much easier for families to hold on to an unrealistic fairy tale that the ABA team will never leave, if no one EVER talks to them about termination of services.


Here are some tips and suggestions  based on places I have worked, and how I have terminated clients in the past. The discharge process will vary greatly from one company to the next, so check with your employer.


How to End Services with a Client


  • Determine why the client is nearing discharge (both voluntary and involuntary). A sample list could include: family chooses to end services, completion of treatment goals, demonstration of improved functioning, absence of significant progress, integration into an inpatient community program or comparable treatment setting, persistent issues with treatment integrity (example: the child is only available for 2 days a week, but the clinical recommendation is therapy 4-5 days a week), company/Consultant inability to effectively provide quality ABA services, and/or persistent noncompliance with company policies including lack of parental involvement.
  • Begin a systematic fade out plan. Discuss this with the family, and together decide how services will be gradually reduced (if the family chose to discontinue services, this may not be possible). For example, reduce the amount of therapy hours, transition to a Parent Training/Consultation model, if seeing the client at home & school transition to just seeing them at home.
  • Provide as much notice to the family as possible, preferably in writing. I am used to funding sources which require 6 month reporting, so I will often alert families that at the next authorization period (6 months away) we will begin transitioning to termination of services.
  • It is customary to prepare some type of Discharge Report for the family that sums up the service history and provides helpful information for the next provider or professional.
  • With the Discharge Report, there should be some type of referral list for the family. This may take some research, like if the family is moving out of state. You want to be able to point the family in a good direction to seeking other professionals who can work with them, even if you are discontinuing working with them for negative reasons.
  • Decide who will collect any company property from the home, and be sure to do this on or before the last date of services. I have been in the awkward position of driving to a home to pick up materials that someone else should have gotten WEEKS ago, and it’s not fun searching through an annoyed mom’s living room to find all the Block Design cards or having to ask her “I only see 2 flashcard sets, didn’t we give you 4??”


*Quick Tip: Here is a sample Discharge Summary Report


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