Photo source: www.madamenoire.com, www.parentingthroughschoolyears.com

 My last post on community outings was aimed at staff/therapists who provide therapy services in the community (at the library, neighborhood pool, a birthday party, etc.). However, there's more to the concept of community instruction than the therapist taking the client into the community. There's also the family/parents being able to participate in their local community.

It is super common that when I start working with a family one of the issues they describe to me is being unable to take their child into various community locations. I hear things like "I have to get a babysitter to go grocery shopping", or "We stopped going to church 2 years ago", or "We USED to go to (insert community location here) but it just got too difficult so we stopped". I hear stories like this on a regular basis where the whole family lives in a shrunken down world of just a few places (i.e. home, school, Grandma's house).

This is always an area I seek to target through intervention, because this is such an unrealistic thing to avoid. Its kind of like failing to teach toileting; this is a life skill that must be addressed.

People live in communities, so to avoid or completely stop taking your child into community settings due to difficulties or challenges is to miss out on a multitude of learning opportunities. I'll say it another way: I learn how to act in a library by going to the library. I learn how to wait in a line at the post office by going to the post office. I learn how to order food in a restaurant by going to a restaurant. Make sense?

Here are some general tips and guidelines for successful community outings:

  1. Go - Yeah.....my first tip is just to go outside. Fear is crippling, and it will lock you in a box. Even if you feel afraid of what may happen or what could go wrong, do not let that stop you from taking your child to community locations. More than being brave, I would emphasize being prepared. Which leads to the next point------ 
  2. Preparation is key - Preparation is one of those things that often gets skipped over. Unfortunately, you don't know how unprepared you are until you are in a rapidly deteriorating scene. So its better to over prepare than to under prepare. If you have ABA staff or are working with a BCBA, schedule outings for when these people will be present. Backup is good. Take your spouse, or a friend with you just in case challenging behaviors occur (also, just having the support is nice). Visuals are your friend. Prep your child in advance by explaining simply where you will go, and what they need to do there. Use a visual to help make your words concrete and clear. Take the visual with you, as well as a few reinforcers your child loves. Connect being in community locations with receiving reinforcement.
  3.  K.I.S.S. - No, not keep it simple stupid: keep it SHORT sweetie. :-)  Especially when you first decide to work on this, I don't suggest taking your child to see a 2 hour movie.....that likely wont go well. Start small. Go walk around the grocery store for 5 minutes, go mail a letter at the post office, go look at fish at a pet store and then walk out. Keep it brief, and leave on a high note (leave before things start to go south). 
  4. Engagement is key - Make sure whatever the setting is, your child has something to do. This is not exclusive to Autism. Kids get bored...they start requesting things....requests get denied...behaviors start. Lets sidestep that whole ugly little chain by going in prepared (see #2). If you're at a grocery store, your child can help put items in the cart and find things on the shelves. If you're at the mall, your child can carry bags. I know some of you may be thinking "My child is not yet at a point where they can follow an instruction or help out at a store". Not a problem. Then bring distractor tasks with you. A distractor task is just something your child can engage with. This could be a kaleidoscope, some headphones to wear, a squishy ball to squeeze, etc.
  5. Stay strong - You knew this was coming, right? Sorry. There's just no getting around it. If behaviors erupt in the community setting what is the last thing you want to do? Leave. Why is that? Well, this will actually serve an escape response which is the last thing you want to do. Over time, your child will start exhibiting behaviors as soon as you drive up to the community setting so that they can leave. I know its hard. I know people stare. I know its embarrassing. I know people will judge your parenting abilities. Here's the good news: over time, as you keep returning to the community setting and following steps 1-4 the behaviors should drop down, and down, and down. Do yourself a favor and go into the community during "dead times": go see a matinee, or arrive to the restaurant 5 minutes after it opens, or go bowling on a Tuesday afternoon. Go out at times when places are more likely to be empty, and all the judgemental people are at work :-)

Lastly, I have to add another huge reason why its so important to take your child out and about in their local community. Earlier I mentioned the dazzling array of learning opportunities available for your child. What about other people in your community? How do people learn to live and interact with people with disabilities if they never encounter people with disabilities? Diversity awareness is not as widespread as some may believe. I encounter the stares, pointing, whispering, or rude comments when I am out with my clients today just as I did years ago as a newbie ABA therapist. When people see you out and about teaching your child skills in the community, they are getting an opportunity to learn and grow as well.

*Resources:

Community Outing social story
Community Outing Teaching Protocol
Going to the Store social story
Going to the Movies visual

Photo source: www.researchhistory.org, www.goodtherapy.org

I've said it before, and I'll say it again: parent participation is critical to the success of any ABA therapy program.

One way that participation can be accomplished is by having parents/caregivers observe the therapy sessions. Particularly when therapy first begins, it may be too challenging to have the parent join the session. This can be challenging for the child, who may not want mom or dad in their therapy session, and it can also be challenging for the parent who is still learning what ABA entails. So a nice compromise I like to do initially is just have the parents sit and watch the session without joining in.

I have a pretty big dislike for therapy sessions that only go on behind closed doors. I do not think that the therapist should arrive at your home, go into the therapy area, close the door, and then in a few hours you see them again as they leave. How is that helpful for the family who urgently need to learn how to generalize what the therapist is doing? From the child’s perspective, this sends a message that they only need to listen to their therapist. So when the therapist leaves…..things can get very hard for the parents.

I tell my staff that one of my goals of treatment is that the therapist can work with that child all over the home, across various rooms, where family members may or may not be present. In other words, treatment should occur naturally and within the context of the typical environment. This could look like playing games at the kitchen table as mom cooks dinner, or practicing bike riding in the driveway next to some siblings. I love to see therapy sessions that are active, loud, full of laughter, and move freely from room to room. Admittedly it may take time and practice to get to this point, but it definitely should be a goal.

Many parents are unsure of what to do when I ask them to start observing, and for some it can even be an uncomfortable or unenjoyable experience. ESPECIALLY if just the sight of you walking into the therapy area causes your child to erupt in problem behavior. If that happens to you, don’t feel alone. It’s pretty common. This just means your child needs more opportunities to get used to your presence during their therapy session, but it definitely does not mean you should leave/walk away when this happens. That will only serve to strengthen an escape response where your child acts out in the session to get you to leave.

So now that you know not to leave in response to problem behavior, what should you do while observing a therapy session? Glad you asked :-)

1.       Observe the dynamic between the therapist and your child- You know your child better than anyone, so what you are looking for is a healthy respect for who your child is as a person. If your child squirms away from touch, does the therapist keep giving huge bear hugs anyway? Does the therapist speak to your child with respect, or in a degrading tone? Does the therapist seem bored or disinterested while teaching? These are all bad signs.
2.       Observe the reinforcement your child receives – What reinforcement is being used? Is it varied, and delivered frequently? Is praise delivered along with reinforcement, or does the therapist just silently hand your child a toy or edible? What if your child seems bored with the reinforcement, does the therapist pick up on that?
3.       Observe how correction or prompting is given during instruction – When your child gives an incorrect response or stops responding at all, what does the therapist do? How do they react? Do they appear frustrated, flustered, or annoyed? If you can read that in their face, so can your child.
4.       Observe how the behavior plan is implemented – Firstly, if there is a behavior plan you should be familiar with it. Observe how the therapists implement the plan, and if they are following it. Are you seeing the antecedent strategies being used?  If your child becomes aggressive, does the therapist know how to react in a calm and neutral manner?
5.       Observe both professional and ethical behavior – This is probably my #1 reason for recommending parents observe, from the perspective of a parent. When I have on my BCBA hat, I want you to observe to learn the treatment plan and ABA strategies. But when I have on my parent hat, I want you to observe to make sure you are dealing with professionals. If you are unaware of the ethical and professional standards for this field, please become familiar with them. Here is a link to the standards for this field. If you directly observe violations of these standards, that is absolutely a bad sign.
6.       ASK QUESTIONS- This is so important I must say it again: ask questions!  The ABA team are not in your home 24/7. It is super important that when they are there you use that time to bring up concerns, problems, or questions. Ask about behaviors, the treatment plan goals, bring up your concerns about the upcoming school year, etc. The team should answer your questions respectfully and simply, minus a bunch of jargon. I also suggest using therapy session time to practice things that are particularly difficult when the team is not around. For example, if you have a rough time every morning getting your child to brush her teeth, practice that skill with the staff during therapy sessions. That is why they are there after all, is to help you!

Just like any new skill, ABA will be so much easier to learn once you have seen/observed what it should look like.
One of the best ways to truly learn how to implement the treatment plan is to watch the professionals do it, then ask questions about any parts that seem confusing…or ineffective…..or overly punitive. I have had some parents ask me some very probing questions which led to some great moments to teach about the application of ABA.  

*Suggested Reading: The Rights and Wrongs of a Parent Observing Therapy


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