Showing posts with label ABA. Show all posts
Showing posts with label ABA. Show all posts

 





Recently, there were many publicized and non-publicized mass closings in the ABA industry. This means many people lost their jobs. It also means many clients abruptly lost access to needed services.


Since this happened, I've talked to parents from all over wanting to know how to recognize a private equity backed company or how to spot warning signs or clues of a low-quality provider. 

It won't always be possible to see shutdowns/company closures coming, and just because things start off going well doesn't mean they will continue that way. Just ask all the families who started off 2020 happily receiving ABA services, and then COVID hit, and then.....yeah.

While there is always some level of trust required, and some element of risk when initiating services with any provider, I also care very much about helping caregivers develop the skills to weed out low-quality providers and avoid the worst of the bunch. 


The biggest tip I can give is the title of this post: interview providers.

Please don't just Google providers in your area, and sign up for services with the company that answers the phone the quickest. This is far, far too important not to do your due diligence. Treat this with the same level of seriousness as researching a new car to buy, or choosing your child's pediatrician, or deciding which private school is best. Choices are great, but choices also come with a responsibility to carefully evaluate each choice. Despite what many people think, nope, low-quality ABA treatment is NOT better than no treatment at all.



TONS of resources below--- use them, share them, download and print them. Listen to your "parent gut", ask questions, and watch for discrepancies between what you are being told and what you actually receive. No provider should start off the client/company relationship lying to you, hiding information, dodging your calls, etc. Yet, I hear stories like that from families all the time (e.g. "Its been bad like this since the very beginning..."). Be a picky parent, and advocate for what you know your child needs. 

Many of the anti-ABA voices out there are products of low-quality, unethical, and terrible ABA services. The potential for harm and mistreatment is high in situations where clients are working with poorly trained, poorly supervised, poorly equipped, or horribly overworked RBTs, BCaBA's, or BCBAs. If it doesn't feel right, it probably isn't right. Conversely, if it seems too good to be true it likely is.



**Caregiver resources**


Hiring Solo Providers: Hiring Direct Staff, Hiring a BCBA, Parent-Led services

Choosing a Company: Center or Clinic, Choosing an ABA Provider, Questions to Ask a Potential Provider, Tips for Choosing a Provider, Sample Interview Questions , More Tips for Choosing

Evaluating the Quality of Treatment: Is it ABA?, Is it Good ABA?, High Quality Treatment, How to Recognize High Quality ABA, What is Good ABA, 30 Indicators of Quality ABA, Helping Parents Choose Treatment

What is Private Equity: PE and ABA, PE and Autism Care, The Impact of PE, List of PE backed providers

Ethical Responsibilities of RBTs, BCBAs, and BCaBAs (Practitioners have ethical guidelines, not companies/organizations. Consumers can file complaints about unethical organizations to their insurance provider, Better Business Bureau, applicable accreditation board, or are encouraged to consider legal action): BACB Ethics, ABA Ethics Hotline, Reporting Licensed Practitioners

Signs of a Low-Quality/Unethical Provider: Good v. Bad ABA, Signs of Low Quality Staff, Exploring Quality in ABA

Food for Thought about the current state of the industry: Low standards in the ABA Industry 

Free Handouts: Tips for Screening ABA Providers , What to Expect When Initiating ABA Services


 Birthday parties. Let's talk about it.


Parties, gatherings, events, picnics, etc., where there will be lots of people, noise/music, activity, chatter/laughing, and hidden, unspoken rules for "appropriate" behavior.

The event may even be outdoors, which brings a whole host of safety concerns.

Or, the event could be near a body of water (pool party), which definitely adds even more safety concerns.


For parents with Autistic children, or another disability, do you just not go??? Is that the way to do this? How do you get a child through elementary school without ever attending a birthday party?? These days, kids have to invite the whole class. So in an average school year, your child may receive several birthday invitations, to loud, active, parties full of running, screaming kids, hopped up on sugar and soda.

Before we jump into what to do, let's back up a bit and describe the challenges: Why are birthday parties sometimes so not fun, and so very hard

Birthday parties/large gatherings are (often) loud, full of junk food/ice cream/candy/cake, full of people, tantalizing presents, music or entertainment, and the expectation to socialize ("You kids go play"). All of this can combine for quite the sensory nightmare.

Your Autistic child may find the event overstimulating, scary, uncomfortable, or painful (overstimulation that one cannot leave can be painful). Your child also may be unable to tell you any of that, which leaves demonstrating the discomfort through their behavior.

I have seen this up close many times, both "on the clock" and off the clock. I've been at kids birthday parties and seen that girl or boy seriously struggling and having an awful time, or attended birthday events with clients to provide support during the party. 

I think its critical to reset expectations and have a clear understanding of just how scary parties can be for Autistic children or adolescents (I'm not mentioning adults because, typically, adults with disabilities are not forced to attend events they seem not to enjoy, the way small children are).


The questions below should be carefully considered based on your child's age, temperament, sensory profile, and support needs, with strategies in place in case the party experience goes badly. Have a plan, then have a backup plan, and don't go it alone. Bring at least 1 other adult with you, or if you are hosting the event, assign helpers among family ands friends who know what to do and will quickly jump in if your child is having a hard time.


Things to Consider:

Do you have to attend/throw the party? No really, think about that. What would happen if you just...didn't go? Or what would happen if your child didn't have a 4th birthday party? I'm pretty sure the earth would still keep spinning. Sometimes, the level of support that would be needed as well as the needed accommodations aren't feasible. In that case, is it better to force your child through something they are unlikely to enjoy, or to just skip it? I'm not saying forever, and this could even be a case by case decision. Small party at a neighbor's home? Sure. Huge community pool party with 6 clowns, a DJ, and group party games? Maybe not.


- Don't try to stay the whole time, instead play it by ear. For some children, they aren't excited about the cake (feeding issues are common with Autism). They don't care about the social games or group activities. They don't yet have the ability to wait, so they won't understand why they can't start ripping into set aside food or activities (and may not understand why they can't open someone else's gifts). What will YOUR child do at the party that they find fun, entertaining, and is safe? Think about that, before you take them to a 2 hour birthday party.

- Understand that vigilant supervision may be needed. This does mean dropping your child off may not be a safe option (as the party host will be super busy), and if you stay with your child, you may need to keep them in eyesight at all times. It isn't unusual for my clients to 100% "veer off from the group" during parties, only to be found sometime later upstairs in a closet, or trying to access YouTube on the family laptop, or casually digging through someone's refrigerator. These can be very embarrassing moments, that could easily be prevented by keeping a close eye on your child, especially if the party or event will be held outdoors.

- Speaking of embarrassing, there is nothing embarrassing about accommodations or supports. If you are taking your child to a party or event where they can't wear their noise canceling headphones, or freely STIM (family members, sadly, can be very judgmental about stimmy kids at birthday parties)  without being treated poorly, that may not be the kind of event you want to attend. Again, parties are overstimulating for many Autistics. So it makes sense that they will do MORE of what helps them calm or regulate in response to being at the party. In other words, if most of the kids are quietly playing Candyland, but your child is in a separate room happily squealing and jumping, while chewing on a straw, will this be a problem for other people at the party? If so, I don't think your child is the problem.

- Take preferred foods, toys, and leisure items with you. Please do not expect that your child who eats 3 foods at home, will magically attend a birthday party and chow down on Cheetos, cake, and pizza. If they won't eat it at home, they likely won't eat it at the party. Also, don't withhold stim items or comfort toys because the child is in public, and other people will see. Those favored items may help keep your child calm and comfortable, in a chaotic and loud setting. On that note, it can be helpful to bring items your child may grab, snatch, or steal, if they see it in public. For example, I worked with a boy once who loved to suck on pencils. If he was out somewhere and saw a pencil, he would try to grab it and put it in his mouth. So in that situation, I'd recommend bringing oral sensory items with you so the child doesn't need to hunt throughout someone else's home for something to satisfy that chewing desire. Think about things like this in advance, and plan accordingly.

- The biggest tip, and the one I see cause parents the most pain and distress, is this: Please don't expect your child to be a different person socially, just because you're at a birthday party. If your child is not very social at home, they likely won't be very social with 23 other kids present. In fact, they may exhibit new behaviors you usually don't see at home (such as pushing, swatting at, or running off to get away from the other kids). This can be very hard for parents to watch. So can bullying and stigma, such as if your child DOES want to join the play, and the other kids are being mean or cruel to your child. Remember that earlier tip about close supervision? It's very important to watch how your child interacts with the other children, so you can stop any bullying or rudeness in its tracks, and so you can monitor when your child's social battery is "full". Most of my clients fill up that social battery very fast.....maybe 15-25 minutes of social interaction, and they're done. And that is OKAY. Not all children want to "Go play" with their peers for hours and hours. Observe your child, redirect them to solo play or maybe a calming activity as needed, and when they seem to be all done with being around so many people, its time to head for the door so the event can end on a high note. Don't be ashamed or embarrassed to say "S/He's ready to go now. Thanks for inviting us, bye guys!". 



I hope the largest theme coming across in this post is that large events/birthday parties aren't necessarily about you, as the parent. They aren't about the party host, the games, the clown, catching up with friends, hanging out, etc. They are about helping your child be successful, in what is likely a highly overstimulating scenario.

It is important to provide your child with the support and tools they need to engage with the event, to endure the event (again, consider if it would be best not to go if they seem to just be "enduring" parties), or to excel at the event. Whether the bar is set at engagement, endurance, or excelling, will depend on your child. 
And don't lose hope and feel defeated if right now, you are at an endurance level. That doesn't mean things will always be that way! As your child grows and matures, and most importantly as they develop more skills and abilities, they may begin to enjoy parties. Maybe even, to have fun at parties.
Give it time, and be patient. Both with your child, and with yourself.





*Recommended Resources & Resources:




Ghanouni, P., & Quirke, S. (2022). Resilience and Coping Strategies in Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders, 1–12. 






 



I have been presenting/speaking, writing, and training on the topic of ABA Reform/anti-ABA sentiments for some time now. I have spent time engaging in intentional community and dialogue with people who disagree with ABA, and even have traumatic experiences from therapy services (some which really should never have been called “ABA”), as well as doing the work daily in my sphere of influence to train up/mentor/coach supervisees on this topic. Lots of listening, closing my mouth, being open to changing my own mind, being open to critique and feedback, and letting people tell their own stories.

 

I’m not alone in this. I know many ABA clinicians and providers who are also moving away from defensiveness and being closed off to criticism or shutting down Autistic voices because they disagree with ABA. I know people personally who have completely changed the way they practice, and I have mentors in this field that I look up to who have helped model for me the way forward, towards a more compassionate and respectful ABA. There is still lots of work to be done, and I know many providers committed to doing that work, every day, across all their clients.

 

However—

 

I get lots of comments, questions, and emails, from anti-ABA people who want me to do more. They want me to close up shop, rip up my certification, terminate all my client contracts, and find something else to do. They want ABA to just go away. Reform isn’t enough, changed mindsets isn’t enough, and listening to the Autistic community isn’t enough.

 

To that, I want to openly and publicly say: I respect your point of view, and I’m not here to tell people what to think. You have formed an opinion and are 100% convinced it is correct.  You believe ABA is conversion therapy, it is abuse, it is terrible, and that any ABA provider must therefore be terrible. You aren’t interested in dialogue or collaboration, you want ABA providers to shut up, and go away.

 

I hear you.

 

But I’m committed to change. For myself, for those professionals within my sphere of influence, for the clients and the client families I support and work with every day, and for the field in general, as far as my own advocacy and activism will allow. I speak out regularly about better ways to do ABA, issues with this field/industry, and the need to better support clinicians, and better train Technicians. I feel strongly about ALL of these issues.

 

To Autistics I say: keep speaking up and keep speaking out. Yes, you will find that trying to dialogue with some ABA providers or company owners will be an exercise in futility. But, there are those of us out here who WILL listen. Who won’t shut you down, who are willing and interested in engaging in respectful communication and truly want to learn. We are here.

 

You may not want to speak to us, you may not want to dialogue with us, and you may not want us to continue supporting individuals and families, but again: We are here. We will remain here, and we will commit to growth, own up to our mistakes, and stop acting like we know it all. We don’t know all. No one knows all.

 

So for those who ARE interested in learning, growing, communication, collaboration, and improving the quality and soul of ABA services: We are here.

 

Let’s work together.

 


** Recommended Reading:

What is ABA/Can it be Reformed?

Toward ABA Reform

A Perspective on Todays ABA

https://www.iloveaba.com/2020/11/aba-haters-pt-ii.html

https://www.iloveaba.com/2021/08/trauma-informed-aba.html

https://www.iloveaba.com/2018/03/normalization.html

ABA Reform Movement podcast episode

List of ABA Facebook Groups

Toward Trauma Informed Applications of Behavior Analysis 

What is Trauma Informed ABA podcast episode

Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2018). Compassionate Care in Behavior Analytic Treatment: Can Outcomes be Enhanced by Attending to Relationships with Caregivers?. Behavior analysis in practice12(3)

Compassionate Care in ABA


 



"McABAs" is my own created term to refer to the low-quality, murky billing practices, mass produced interventions ("cookie cutter" programs), undertrained or nontrained RBTs, and overworked and harried clinicians, kind of ABA providers.


Similar to how when your body is hungry and in need of sustenance, I don't recommend reaching for a greasy fast food bag of empty calories, if you are in need of high-quality, professional, ethical behavior analytic services I don't recommend calling up a McABA.





The problem is, low-quality providers may not look/seem like a low-quality provider. Unlike fast food chains, you can't just look for the obvious golden arches or the blatant drive thru window.


As a caregiver, parent, or person seeking ABA services for themselves, it is critical to learn to weed through your options, weigh one place against another, and look for red flag concerning signs and indicators of a low-quality provider.



The following resources should help:


https://www.iloveaba.com/2018/04/weeding-out-bad-youre-fired.html


https://www.iloveaba.com/2012/10/choosing-aba-agency.html


https://www.iloveaba.com/2011/08/how-to-have-very-short-career-in-aba.html


https://www.iloveaba.com/2021/07/choosing-aba-provider-pt-ii.html


https://marybarbera.com/tameika-meadows-finding-good-aba-therapy/











"The mind is not a vessel that needs filling, but wood that needs igniting" Plutarch


"Autism isn't something a person has, or a shell that a person is trapped inside. There's no normal child hidden behind the autism" J Sinclair 


There used to be a school of thought in the Autism world that the individual was somewhat of an "empty vessel" waiting to be filled. A blank slate, trapped within a hard to understand shell and wanting to emerge.


No. 

And what a harmful, disparaging view of individuality.


Autism is not being without/lacking, it's being differently tuned with interacting with the world, environment, people, and situations. 

It's sometimes being MORE when the situation calls for less, or being LESS when the situation needs more....Less attentive, less sensitive. Or possibly more attentive or more sensitive. 

There is no one clear way to be Autistic. 

What is super important to know is that every client you work with already is full of information and knowledge when you meet them. Some cannot share or demonstrate that knowledge, but that doesn't mean it isn't there. Or maybe they show it in a way you aren't used to, or aren't prepared for. 

Regardless, the capacity to learn and grow is within all of us. 

 



Is Telehealth ABA here to stay post-pandemicOr should we wave goodbye to a solution that solved many problems when COVID first hit? What does the future of ABA look like?


Well, definitely across many other industries: Hybrid or Remote work is here to stay.


As COVID continues...and continues, now is the time to start looking ahead and considering where Telehealth belongs in the world of ABA. Front and center? Or a "break glass in case of emergency" temporary solution?

During 2020, many of us relied on remote services and/or technology to teach our kids, bring our groceries, attend professional conferences, receive doctor check ups, or check in on family and friends. Video calls became a way of life. ABA therapy was not exempt from that reality.

But many ABA companies that were forced to embrace Telehealth during the height of the pandemic are now starting to look into moving away from Telehealth, re-opening clinics at full capacity, going back to school based services, and reintroducing group therapy formats (such as social skill groups). Carefully, of course, and while following local and state level mandates.

I see lots of discussion and news content focused on should ABA Telehealth continue for clients (Is this the best decision for the clients). But little focus on "What about for the professionals?". Do ABA providers have a preference between Telehealth services and non-Telehealth services?

The answer to that question may vary according to comfort level/familiarity with technology, age of client/populations served, and the specific ABA provider. RBT's may be less comfortable with Telehealth than BCBAs. Or, vice versa. There are pros and cons on both sides of this issue, but the main takeaway here is this type of clinical decision needs to be made with all parties involved. And that includes the professionals/providers, not just company owners/employers, or clients and client families.


First, let's clarify what is meant by Telehealth:

Telehealth ABA services are provided virtually through HIPAA compliant means, usually a combination of video and audio that occurs live-time during the session. Typically, funding or clinical need is most appropriate for Telehealth BCBAs. While RBTs can work virtually as appropriate for the client, funding does not always allow for this.

Telehealth typically is utilized for homebased services, although clinic or school based providers can utilize Telehealth as well.

Virtual service delivery already has a long, established history in other fields such as Mental health counseling, Psychological services, and Medicine. Telehealth is not new. However, the field of ABA embracing Telehealth IS fairly new. Prior to COVID, many insurance funders did not even have billing codes for Telehealth services.

At the BCBA level, all service delivery can utilize Telehealth (as appropriate for the particular client), including assessment, parent support, and RBT supervision.


So why the pushback against Telehealth? Why do some funding sources, employers, or practitioners seem so against Telehealth? Well, sometimes Telehealth is applied with a broad brush to clients it may not be appropriate for. I know of clinicians who are currently very anti-Telehealth because of how they've seen it done, or having it thrust it upon them at work with little to no training or support. If you are a BCBA who hates Telehealth, did anyone take the time to train you on its use? Do you have someone to reach out to with troubleshooting and questions? If you are a RBT who hates Telehealth, was it explained to you at the onset of the case? Did you know going in the BCBA would not be on-site with you? Its important to separate personal bias and preference from the use of technology to provide services. Just because you do not like Telehealth, does not mean its all bad.

When utilized in an evidence based and ethically sound ways, Telehealth has numerous benefits. I have been utilizing Telehealth to service families since 2010. If it had not been an option, these families may have gone without help and assistance. For international or rural families, professional help may not be located up the street. It may be located in a different state, or country.

Telehealth allows me to clinically supervise in discreet, non-disruptive ways that minimize client reactivity. It allows me to easily hold progress meetings with client families who may not be available during scheduled therapy sessions. I can have a 20 minute videocall with a client's dad while he's on his lunch break at work. Trying to do that in person/on-site would present many logistical challenges. 

Telehealth allows me to work for a living while also being home to support my OWN family, during this pandemic craziness. I have a few close friends who are new moms, and if they did not have the option to work via Telehealth through their maternity leave and beyond, they would have been left with no choice other than resigning from their positions.


Lastly, I think the largest benefit of Telehealth ABA services may be explained in this data:

  • United States – 1996 BCBAs in the state of MA
  • United States – 107 BCBAs in the state of Nebraska
  • United Kingdom – 321 BCBAs  
  • Australia – 111 BCBAs 
  • United Arab Emirates – 104 BCBAs
  • Russian Federation – 33 BCBAs
  • India – 27 BCBAs
  • Spain – 26 BCBAs
  • Brazil – 10 BCBAs
  • Nigeria – 1 BCBA
(Source: www.QBS.com)

These numbers are a very sober reminder that Telehealth is not just about personal preference, pandemics, or open-minded employers. As the demand for ABA continues to grow, the supply is not keeping up. We have far more people in need of service, than qualified providers available to help.

Telehealth makes it possible for 1 BCBA to service clients who may live in different zip codes, states, or countries. It helps companies with dire staffing deficits open up their services to more clients, it helps RBT's in dire staffing areas receive clinical support and BCBA help, and it attracts (and possibly retains) BCBAs located out of area. 

Gone are the days where the ABA provider needs to spend 7 hours in their car crisscrossing the city to see 3 clients. Now with Telehealth, not only can those 3 clients be seen WITHOUT traffic jams, but the provider could add on more clients in the same day. Removing the commute means staff spend more time working, and less time sitting in traffic (aka increased productivity). 

Opening up Telehealth services means getting families off of waiting lists, and starting up services. No more waiting months to locate and hire a BCBA in the area.

Also, sickness/illness: What about minor but still contagious illnesses, such as pink eye, stomach virus, strep throat, rashes, etc.? The provider doesn't need to cancel the session when they can just implement Telehealth instead.

What about when staff move out of area? Instead of losing quality providers, forcing the family to accept the transition, and disrupting care, how about the BCBA remains on the cases via Telehealth?

Just being able to offer Telehealth/work from home as an option to employees/staff means being a more open-minded, accommodating, and future focused employer. It is attractive to applicants when a work setting provides options. 


Again, Telehealth may not be the appropriate choice for every client or family. But, when appropriately utilized Telehealth can make the job of the ABA clinician easier and more efficient. And what employer isn't a fan of efficiency? ;-)


*Further Reading/Resources:

What does Telehealth ABA Look Like?

Telehealth for Children with Disabilities

Telehealth ABA - Best Practices

Moving Forward while Staying Home 

Practical Guidelines for Telehealth ABA

Therapy During COVID 19

Telehealth: Challenges & Solutions

Rapid Conversion from Clinic to Telehealth ABA 

Guidelines for TelePsychology 

Guidelines for Telehealth Related Ethics

Is Telehealth ABA Here to Stay?


 


See Part I, which is helpful for families needing to know how to prepare the home for ABA services.


I couldn't just leave this topic 1/2 complete. 


Of course, it is important for families to know what to expect of home-based ABA services and general "Do This" & "Don't Do This" guidelines, but it's also important for ABA staff and clinicians to know when home based ABA services are inappropriate, the home setting is unsafe or hazardous, the home setting needs stricter guidelines, or is downright dangerous to staff and/or the client.

I'm not ignoring ABA that occurs in other settings, but for clinic or school based ABA services the environment/facility is typically set up in advance. It is monitored and controlled by management or clinicians, and regularly cleaned and maintained. Certain items are prohibited to be on-site, there may even be security or at the least, janitorial staff. 

The home setting is unique because as the staff going in, we do not have full control over the environment. We don't know what hazards are present unless someone tells us. Sometimes we don't even know how many people (or animals) will be in the home from one session to the next. We may not know what is broken/damaged in the home, or may pose a health concern when we arrive on Day 1, ready to work.


So, this is a pretty big deal. 

To all the company owners and supervisors/BCBAs, this kind of "home safety checklist" needs to be developed with a home inspection occurring before the case starts (during intake/assessment). RBTs should not have to walk blindly into the home of a stranger, with no idea what dangers or challenges may be present.

I recommend that whoever schedules the assessment and makes initial contact with new families explain the company policy related to home safety, make sure to answer any parent questions or address parent concerns, and do a walk-through inspection (this could also occur virtually).

Companies will vary with what is required or expected of the home setting, and sometimes state regulations or funder specifications will apply. 


Unsafe/Inappropriate conditions in the home may negatively affect the client, such as: profuse sweating through the session because sessions occur in the non-ventilated and dusty attic, the parent blaring loud rock music throughout the session, or being unable to let the client play in the backyard due to huge amounts of dog feces.

Unsafe/Inappropriate conditions in the home can also negatively affect staff, such as: excessive and unwanted flirting and sexual jokes from the client's father, having to park in a nearby unsafe area as only street parking is available, or bringing pests into your own home that crawled into your materials bag during the session.

How exactly is learning or teaching supposed to occur under these conditions??


I could fill this post with pages and pages of home-based horror stories, but instead I'll just simply say: Home based ABA won't be possible for every family that wants it, for a variety of reasons. 

And that's ok

Services may need to occur at school, at the clinic or center, or in the community (such as at a library) until issues in the home can be adequately and safely addressed both for the benefit of the client, and staff.



**Resources:

Free checklist download to help set policy/establish minimum requirements for home-based ABA services to occur. 

Home Based Employee Safety

Ensuring Safety during In-Home sessions

Firearms & Home-Based ABA: Considerations for Safe Practice


 



Today's quote is from...me! From a recent podcast interview with Dr. Mary Barbera:

"Good ABA start with parents. So, for any parent or caregiver, if you are trying to determine a quality place for your child to receive ABA services, you really have to start by looking at what's the goal of intervention. I really feel like that's like the foundational first step, because if you are speaking with a company or a provider and they're talking about: 'We're going to fix this, we're going to correct blank, we're going to make your child more.../ We're going to remove stigma',  and other words like that, all of those words are getting at normalization. Which should not be the goal. The goal should not be to magically make it as if your child were born differently. The goal should be to give the client as many supports as needed to contact the things they to need to contact in life. For example, letting people know when you want food, using the bathroom,  attending school, etc., because in certain parts of the world children with disabilities don't attend school. So, we really have to look at what this means for the client and removing barriers to being able to do different things in their life. And then we address each barrier one by one. That should be the goal of ABA. 'We're going to help your child do _____/We're going to make it easier for your child to do ____". That should be the kind of language that is being said by a provider, or by a company.  It should be very, very concerning when you are contacting an ABA provider saying you need help and that provider is instead telling you, 'Here's what we're going to do', and they're not listening to you and they're not taking your input and they're just saying, 'Oh, yeah, yeah, we know what to do. We know autistic kids. Here's the standard protocol. Here's the strategy'. No, that is not how that should work. Absolutely not."



Good ABA services are a must for some people. Yes, people. Not just small children.

It can be a must for disabilities beyond Autism.

It can be a must inside of the classroom.

It can be a must in adult day programs and residential settings.

It can be a must when harmful, destructive, violent problem behaviors are serving as a barrier to least restrictive settings and placements.


ABA intervention at its core, is about teaching new skills and removing barriers that get in the way of learning and being successful in life. NOT a push for normalization.

Quality intervention that is generalized across caregivers and settings, can bring about amazing long-term success and developmental gains.


Take a listen HERE for more tips on distinguishing between good & bad ABA providers.







 

"This is hard" is a statement I often hear from families both in the midst of intervention, and pre-intervention during the assessment phase.

Families without support and services find it hard helping their Autistic child navigate the world, and families in the midst of therapies and interventions find generalizing them to be hard.

It's hard to consistently generalize an intervention plan outside in the home, on the weekends, on Sunday at the grocery store, on vacation at Grandma's house, or at 6am on a Saturday when your child only slept 2 hours.


But its also hard to supervise/monitor your child 24-7, to break up sibling fights all day long because your child can't share, to find quality childcare options when your child is highly aggressive, or to figure out if your child is ill or sick when they can't tell you.

Both are hard.


It is rarely a discussion of hard vs easy, and much more common is a decision regarding which "hard" is acceptable. Yes, toilet training is hard work. On the flip side, changing an 8 year-olds diaper isn't exactly easy. Nor is it easy to afford to buy diapers for that many years.

Yes, teaching your child to use utensils instead of eating with their hands is hard. On the flip side, restricted diet and issues around mealtimes can be made worse if the child will only eat finger foods (typically, starches and carbs). That is also hard.

Yes, it is hard to consistently follow a Behavior Plan when in public with your child. On the flip side, being asked to leave locations, having friends ask that you not visit, or being scared someone will call the police on your child during a public outburst, is a hard reality to live out.

You have to decide which "hard" to accept.


I intentionally use the phrase "intervention plan" and not "ABA therapy", because maybe your child isn't receiving ABA services. Maybe you don't want that, or can't access it.

But are they receiving Speech services? OT? PT? In special education at school? Attending an Autism preschool program?

If so, these are all interventions designed to minimize developmental delays and target current deficits.


Whatever kind of intervention your child participates in, there are a few components that tend to be the same across different therapies:


1. Consistency. In order to be effective, the intervention must be applied consistently. Frequent staff turnover, frequently canceling appointments, or other issues like this can negatively impact results.

2. Training must carry over to the home setting/caregivers. There is no way to generalize the intervention if you have no idea what it is.

3. Caregiver Participation. In order for #2 to happen, the caregivers must be willing and available to participate in the intervention/treatment plan.

4. Focus on progress vs miracles. Progress can be slow, it can be up and down, and at times it can mean treading water. Sometimes an absence of regression IS progress. If you have sky high expectations of the intervention process, this can cause "provider hopping" where families move from one agency, provider, or intervention to the next looking for magic. That just is not how quality, ethical treatment works.

5. Individualized Intervention. It doesn't matter if your child receives 30 minutes of Speech each week, or 15 hours of ABA. Are the treatment goals and the teaching methodology suitable and appropriate for your child? "Cookie-cutter" intervention is when treatment is applied in a lazy, vague, and generic way across multiple clients. In order for intervention to be effective, it must meet your child where they are and incorporate their unique interests and motivation(s).


*More resources below:

Happy or Therapy?

The Easy Way vs The Hard Way

Evidence Based ASD Interventions 

Effective ASD Interventions 



 

"If you want to see competence, it helps if you look for it"

Douglas Biklen




To presume competence is very important considering the work that many ABA professionals do with highly vulnerable populations who may be unable to reliably communicate/self-advocate and could also have high support needs on a daily basis.

It is important to always place a high value on dignity and self-determination, to whatever degree is possible for the individual (your child, student, client, etc.). What do YOU want to eat (and absolutely NOT want to eat)? Where do YOU want to sit? Is that shirt comfortable? Do you like this school? Are you feeling okay? Are you hungry...tired....ill...bored....sad?  

It may not be possible for the individual to answer questions like this, but to presume competence is to assume that the individual absolutely has an opinion on these matters, even if they are currently unable to communicate that opinion to anyone. Make sense?


Here are more tips on how professionals/teachers/caregivers can work toward intentionally presuming competence:


- Always ask before giving assistance and let the person tell you what you may do to be helpful (for those who cannot tell you, read body language/cues for removal of assent).

- Treat adults as adults. Use a typical tone of voice, just as if speaking with a friend or co-worker. 

- In general do not assume a person can’t read, but also don’t assume they can.

- Speak to the person directly, not the support person, parent, or companion. 

- Don’t assume a person who has limited or no speech cannot understand what is being said around them, or to them. People usually understand more than they can express. 

- Never pretend you understand what is said when you don’t! Ask the person to tell you again what was said. Repeat what you understand. 

- Do not try to finish a person’s sentence, or cut them off. Listen until they have finished talking, even if you think you know what they might say. 

- You might not be able to see someone’s disability. All disabilities are not visible. There are many disabilities that are hidden within a person. 

- Avoid using stereotypes in your thinking. We all have different personalities and our own ways of doing things. To find out what a person prefers, ask them directly (when possible). 

- Offer compliments but avoid giving a lot of praise when people with disabilities do typical things. 

- Avoid speaking for others. Encourage a person to speak on their own behalf. If you must restate something, be careful not to change the original meaning.

- Be mindful of your body language, tone of voice, and other gestures that may influence a person’s decision/desire to please those in authority. 

- A support person should be low-key, almost “invisible” to others. Don’t “over-support.” 

- Let a person make their own decisions. Don’t take over and make decisions for them. It can be difficult for some with disabilities to make quick decisions. Be patient and allow the person to take their time. 

- Focus on what a person CAN do, instead of hyperfocusing on deficits. 

- Find ways to include a person in a conversation. Do not talk about the person to others as if they’re not there/not in the room.



Link to Reference: Curriculum for Self-Advocates

 



When it comes to the treatment or reduction of challenging, disruptive, dangerous problem behaviors, regardless of the setting or populations served, this will often be referred to as “Crisis Intervention”.

This concept is far broader than ABA, as many institutions and facilities will create, monitor, and implement crisis interventions whether anyone on site has received ABA training, credentialing, or licensure, or not (examples: police, schools, daycares, residential settings, prisons, etc.).

Being such a broad topic, that can look about 10,000 different ways depending on the setting and availability of highly trained specialists, it should come as no surprise that crisis behavior scenarios frequently result in injury or even death. If you do some online searches for news stories related to seclusion and restraint, regardless of the setting, you will see what I mean.

This issue is also larger than disability.

Yes, most of the horror stories we see on the news where someone was seriously injured during a restraint DO involve people with disabilities (whether it was known at the time, or not). But in the absence of disability or mental health issues, crisis management can still lead to serious injury or death. That could be for the person(s) responding to the crisis, or to the person(s) having the crisis.

This is a very weighty and complex topic, and I can’t possibly cover everything anyone should know about crisis intervention. However, due to the seriousness of crisis scenarios and the increased risk of harm (again, for the person intervening, the person or having a crisis, or even both of those people), I very much want to share some resources and information about managing behavioral crises.


First, some terms. Here is my favorite definition of a crisis:

A time of intense difficulty, trouble, or danger; a time when a difficult or important decision must be made.

 

During a behavioral crisis, the individual is having intense difficulty or trouble. They are having a hard time (not giving you a hard time). Decisions must be made, not just regarding what to do RIGHT NOW, but in the future, in case this happens again. Which, without the proper supports in place, the crisis event is highly likely to happen again.

Viewing a crisis through this lens takes the responsibility off of the individual having the crisis, and onto the supports in place (or lack thereof). When a crisis event occurs, ask yourself these questions:

1.       1. Does this individual know how to safely de-escalate during a crisis event?

2.       2. If yes, then why are they not using that tool?


Truly individualized and effective de-escalation tools are best understood as the means by which an individual in a crisis state can identify they are approaching a crisis state, select a de-escalation method, implement the method, and lastly evaluate how well the method worked once they are calm again.

Depending on the setting, availability of support help, and the understanding of de-escalation (or lack thereof), this “returning to neutral” process can take minutes, hours, days, or may not occur at all. It may involve a team of people, a caregiver or support person, or happen independently. When it doesn’t occur at all, that typically results in emergency room visits or admittance into an inpatient facility.

I do not know your work setting, the populations you serve, or your job title, but if you are reading this post I have to assume you have either experienced a crisis event with a client/student/etc. or want to be equipped if it should happen.

Right here I have to point out a very common myth, that can be quite dangerous when people believe it: In the field of ABA, clients who exhibit (or have a history of exhibiting) highly violent or dangerous problem behaviors may be classified as exhibiting “severe behavior”. It is a myth that only severe behavior clients can have crisis events. That is not true at all. Clients with non-violent or less disruptive problem behaviors, under the right set of combined circumstances, could have a behavioral crisis. For example, what if their home routine is significantly disrupted, they are ill, dealing with a change of medication, and also recently started puberty? These setting events when combined, could trigger a crisis event. For this reason, it is important for professionals and practitioners to be properly trained and equipped for crisis conditions, far before they are needed.

Now I want to speak specifically to ABA implementers (RBT’s, paraprofessionals, etc.) who work directly with clients: If you are working with clients where you are regularly responding to crisis events or working with clients with a known history of crisis events, you should be following the policies of the physical management training you received. If you have not received any physical management training, then you should not be working with those clients. It is dangerous for you, and dangerous for them.


Again, crisis events could potentially happen at any time, with any client/student/etc. It would be unwise to think “Oh I don’t work with severe behavior individuals, so this doesn’t apply to me”. For ANY of us (disabled or not, mental health issues or not) the right set of circumstances could trigger a crisis event.

If you were in the midst of a crisis event, who would you want helping you? Someone reacting on impulse or instinct, or someone who has been thoroughly and properly trained on safe de-escalation?


So what can be done? Glad you asked.

 There are many, many crisis intervention and de-escalation resources readily available. If you are not in the position to set policy or choose employee trainings, you can still request additional training from your employer and send them recommendations of evidence-based methodologies. You can also always communicate when you feel ill-equipped or prepared to work with a specific student/client/etc. or feel unsafe.

Research shows that in the absence of individualized, evidence- based crisis interventions, individuals will contact injury to self and others (Burke, Hagan-Burke, & Sugai, 2003), receipt of medications with serious side-effects that rarely correct the causes of the behaviors (Frazier et al, 2011), receipt of intrusive, ineffective interventions that are punishment-led (Brown et al, 2008), and increased negative interactions (Lawson & O’Brien, 1994).

 In ‘Effects of Function-Based Crisis Intervention on theSevere Challenging Behavior of Students with Autism ‘, the following procedures are recommended for crisis intervention planning-

Be cognizant of crisis needs and function when designing a behavior plan for students with crisis behaviors, and operationally describe steps to be taken for each phase of escalation. When describing these steps, be aware of the behavioral function. Change the quality of reinforcement delivered between appropriate and inappropriate behavior, and prompt appropriate behavior before providing access to calming activities. Train staff to competence on the intervention strategies (which most often includes role play scenarios during training, not just discussion/lecture). 

 

 


*Recommended Resources (please share!):

 

~Find the number for the mental health crisis/emergency support services in your state, and save it in your cell phone

~For caregivers, if your child is on medication the Physician/Psychiatrist will likely have an after-hours or emergency help desk. Save that number in your cell phone


https://crisisintervention.com/

https://www.pcmasolutions.com/

https://www.marcus.org/autism-training/crisis-prevention-program

https://qbs.com/safety-care/

Crisis Intervention Strategies

Prevention of Crisis Behavior

Crisis Help in Georgia

ASD & Crisis Behaviors

Handbook of Crisis Intervention and Developmental Disabilities

ASD & De-Escalation 

Crisis Prevention Institute 

ASD & Stages of Behavioral Escalation

Nationally Certified Crisis Training Providers

 Recommended Reading: What is the ABA Reform Movement (ABA Haters Pt. II)?


 


You may be a caregiver, professional, teacher, or someone simply interested in ABA as you read this.

 

Regardless of how connected you are to the ABA community, you might not be aware of ABA Reform, what it is, why it is needed, and changes that are being made, right now, in both large and small ways.

 

In case you are unaware, let me walk you through the ongoing conversation a bit. It will help shed some light on why "Trauma Informed ABA" is a thing, and why it’s a much-needed thing:

 

Both within and outside of the professional ABA community, there are people who want to see ABA adapt, listen more to the very populations we serve, reflect on our past (and sometimes current) practices, grow, learn, and in general: Evolve. The way to bring about this change does differ, with some people wanting ABA therapy to end/be abolished, some people wanting to see wide, sweeping change at the top levels of the field, and other people believing that practitioners doing their job differently everyday, in small and impactful ways is how we accomplish change. Different people have different perspectives, so it makes perfect sense to me that although many people are talking about changing and improving ABA therapy, there is little consensus on just how to do that.

 

So how does this connect to trauma informed ABA?

 

Trauma Informed ABA can be operationally defined as recognizing that someone's history, lived experience through their own eyes, and mistreatment or microaggressions has a direct impact on how they behave. It is viewing someone through the context of who they are in the world, and how they self-identify OR are identified or labeled by others. For example, a history of abuse, crisis event, significant illness or injury, neglect, mistreatment, prejudice, misjudgment, or social rejection, are all traumatic events that should influence how any intervention or therapy is applied and carried out.

 

In a nutshell, trauma informed ABA is an intentional decision to provide services and care in a highly personalized, unique, person-respecting manner, and to recognize that we are all products of our environment. For good, or for bad.

 

If you are an ABA professional, you may be thinking "Well....obviously. I already do this in my practice". I'd invite you to dig a little deeper and consider some of the strategies and techniques you implement through the lens of your client (put yourself in their shoes).

For example, I've worked with many young children who have been kicked out/asked to leave multiple daycares or preschool settings before I ever met them. How did those experiences affect them? What must it have felt like to be in a setting where you are excluded, not wanted, misjudged, and your needs weren't met? What kind of interventions and consequences to problem behavior were attempted before the facility realized they could not meet the child's needs? How did those failed attempts at consequences make that child feel? But here is the problem: for most of the clients I serve, I cannot just ask them these questions. Even if they communicate by speaking, they don't always have the vocabulary, cognitive understanding, or desire/motivation to answer these kind of questions. And of course, asking someone's caregiver or parent to speak on the client’s traumatic experience is not quite the same as asking the person who lived through it. Is it starting to sink in now??

 

As ABA professionals, we must approach each client uniquely and specifically, meaning we make little assumption from one client to the next. We modify and tailor intervention to what the client needs and prefers, not what we think is best or should happen. We collaborate with caregivers, parents, and other professionals working with that client, and we design intervention in a way that respects client dignity, autonomy, choice, and again: preferences. If my client hates washing dishes, is it unethical to utilize reinforcement to teach them this skill because their parents want them to wash dishes? If my client has a meltdown in a public space, should I immediately take them out to respect their dignity in that moment or is that "reinforcing escape behaviors"? If my client is non-compliant, is physical prompting necessary? How do I respond during a session when my client revokes their assent? What about a client who is older or able to communicate, and tells me they don’t want to receive ABA therapy. How should I respond? How do I select treatment goals for a client who has no means to communicate? How do I make sure I am embedding client choice? Is it ethical to create a Behavior Plan for stereotypy? What about teaching play skills? Is this ethical or not?

 

These are not easy questions to answer, which is the whole point.

For client A who has a very specific background, I may answer these questions one way. But then with client B who has a history of trauma, school refusal/aversion to authority figures, or past experiences with a low-quality ABA provider, my answers could be completely different. And that is how this should work, with the intervention package looking quite different from one person to the next. That’s a GOOD thing.

 If the care being provided is individualized, focused on what is best for that individual (and not just their caregivers/parents), and trauma informed, then the intervention will ultimately be far more helpful, impactful, and SAFER/less harmful to the individual receiving therapy services.

 

There's tons of valuable information, research, and resources about trauma informed ABA (here is a massive list of resources). I urge any ABA professional reading this to dig into this methodology and embed it into the way you do your job. Listen to Autistics who speak about their life experiences, meltdowns, sensory issues, and their daily challenges. I have worked with many Autistic RBTs or BCBAs, and learned so much from them talking about their own experiences as a child, in school, in therapy, as an adult, etc.

 In order to gain new perspective, you have to be willing to be wrong. Be willing to say "Wow, I didn't know that", “I don’t know/I need to research that further”, or "I never thought it about that way". This how we learn.

 

There is a movement happening all around us, and while it may have many differing voices, that does not negate the need for change. We CAN do better at how we help our clients, how we listen to our clients (especially those who do not communicate by speaking), and how we serve the disabled community.


*Check out these great resources to learn more:


Trauma Informed Behaviorism 

Trauma Informed Care for Behavior Analysts 

'What is Trauma Informed ABA?'

A Perspective on Today's ABA (Dr Hanley)

ABA Provider Listening Pledge (video)

The Compatibility of ABA & Trauma Informed Practice

Examining Challenging Behaviors from a Trauma Lens

Parent perspective on the importance of listening to Autistic voices





I already have a post with tips for evaluating the quality of your in-home ABA provider.


But what about those families who want clinic/center (these words are pretty interchangeable, so for this post I will just use "center-based ABA") based services? What questions should families ask during intake? What are some potential red flags? Should parents directly observe sessions or is that too distracting?


Keep reading, and hopefully I can help answer these types of questions.

As ABA therapy services continue to grow and expand (fueled largely by increased funding, which leads directly to increased providers/companies) center based treatment is becoming more prevalent.

When I was first certified as a BCBA, there were less than 5 center options in my local area. Today, I would estimate that number to be over 100. If you are reading this and you live in a fairly urban or metropolitan area, then you likely know of at least a handful of ABA centers in your area.


Parents contact me all the time with so many questions about center based treatment. When it comes to ABA therapy, the experience can be quite different from other therapies. 

Many families have experienced center based treatment via Speech Therapy, Physical Therapy, Counseling or other Mental Health services, or Occupational Therapy. But these are usually 30 to 50 minute appointments that occur once a week. ABA therapy is often highly intensive, and sessions can occur daily. There is also (usually) a focus on setting up a day that resembles a preschool experience, including large group instruction, recess, school readiness instruction, toilet training, lunch/meals eaten as a group, Art or Music, etc. It is a busy, very planned out, full day experience.

Centers differ as far as policy and procedure, so there will be variability from one company to the next regarding how parents are included in the intervention process. There will also be variability related to state laws, funder requirements, or if the center is part of a chain (usually owned by massive private equity firms) or a small center with an owner on-site. So just know that some of the suggestions below may be more or less applicable to your situation.


First, let's answer a few questions-


"Which is best, home or center based ABA?" - There is no concrete answer to this. It depends on your child, their needs, the priority of intervention, etc. Obviously, if peer/social interaction is a priority then center based services have the advantage of peers being on-site. However, many parents have concerns that their children will pick up new challenging or inappropriate behaviors if they spend their whole day with other disabled children. So as you can, there are pros and cons to center -based treatment, just like with home -based treatment.

"Why do we have to agree to block scheduling?" - A block schedule is when the center only offers a few options for scheduling. For example: 'Part time - 8am-12pm, Full time 8am-5pm'. This usually has to do with consistency in scheduling staff, and the major disruptions to other clients that can be caused by changing staff schedules. For the most part, centers do not have the same scheduling flexibility as in-home treatment. If your family needs a more flexible, adaptable schedule that can change from time to time, then you probably would not be a good fit for center based treatment.

"My spouse and I both work full-time and center based is easier because it has the same schedule as day care/preschool" - Yes, many parents prefer center based intervention due to the schedule (child is there all day). However, ABA is not respite. It is important to look beyond the ease of the schedule, and to determine if a center based setting is the best fit for your child and their needs. Also, 2 working parents can make parent involvement very difficult when it comes to center based intervention. Which brings me to the next commonly asked question........

"How does parent training/caregiver support happen at a center if both parents work full-time?" - This can be challenging. Usually, for center based intervention at least one parent will meet with the case BCBA on-site, each month, to go over client progress. If neither parent can do this on-site, this meeting could be held via Telehealth. If that still is not a feasible option, then it is likely center based intervention isn't a good fit. I would suggest home based services that occur in the evening hours or on the weekend, so parents can be actively involved with treatment. 


Now, let's talk about indicators of quality-

High-quality center based ABA providers will look like a high-quality home based provider for the most part. There should be credentialed individuals (e.g. RBT or BCaBA) working directly with your child and overseen by a BCBA, there should be an initial assessment conducted to create an individualized treatment plan, there should be ongoing monitoring of the intervention and data analysis, and there should be clear, transparent billing, supervision, and staff training policy and procedures. 

As a parent, you should know who is working with your child on a weekly basis (this may vary, due to staff vacation, illness, or changes, but you should know when it varies). You should know what goals are being targeted with your child, and how they are being taught (most parents never ask). You should know the Behavior Intervention Plan, or the strategies being used to reduce harmful or inappropriate behaviors. You have the right to watch/view these procedures and be trained on how to implement them at home. The center facility should be clean, appropriately staffed, have both passive and active play areas, have an appropriate person to bathroom ratio, doors and windows should be secured (monitored with alarms, locks, etc.) to keep clients safe, there should be ample toys and materials, etc. Not only should you be able to tour the center as a parent, but you should be able to see where your child receives 1:1 intervention and to examine the therapy space.


And of course, I cannot leave out potential red flags. Occurrence of any of the items below should raise your concerns, and lead to an action step (Speak with the facility Director or Manager, talk to your case BCBA, and if necessary, remove your child from the program)- 

  • The absence of any of the criteria described for a high-quality ABA center
  • Staff/Director or Manager are consistently angry, upset, or otherwise seem miserable. Do you want to work with people who are miserable every day? Then why would your child want to?
  • Poor communication/No communication, specifically when it comes to billing/invoices/charges, clinical supervision, conflict with the staff, or behavioral strategies used
  • Your child experiences significant regression after starting services at the center
  • Massively high staff turnover. I say "massively high" because ABA as a field is known for high staff turnover. But, if you have been at the center less than 30 days and can't keep track of who is on your child's team---> that is a problem.
  • Lack of outdoor space where clients can play and get fresh air (many centers today are located in business/office spaces that lack outdoor play areas)
  • Lack of toys, materials, or manipulatives for clients to play and explore
  • As a parent, you are pushed to sign on for an amount of treatment hours you are not comfortable with, and do not feel are necessary
  • As a parent, you are never allowed on-site. Yes, there is HIPAA, and client confidentiality, and all sorts of reasons why parents may not be able to just walk in any time, without exception. BUT, the center should have figured out a way to remediate this issue. For example, a discreet meeting area or conference room where BCBA or Director meetings occur, a waiting area where parents can request to meet with their child's RBT or team members, or discreet observation windows where parents can view their child during therapy unobtrusively
  • As a parent, you are pushed to terminate services with other providers to focus only on ABA. Or, you are pushed to terminate services with other providers and swap them out for services offered at the center
  • If you do not know what your child is working on (treatment goals), never received any data, reports, or graphs, or your child is working on things you specifically rejected or said you wanted removed from their treatment plan----> that is a big problem.



*Further Resources:







 



Recommended Reading:

VB -MAPP assessment tool

ABLLS-R assessment tool

AFLS assessment tool

The Practical Functional Behavior Assessment


There are many commercial assessment tools out there that are purchased and utilized by ABA practitioners, typically at the BCBA level (BCBAs typically are the ones conducting new client intake). 

Often when I work with supervisees (meaning individuals pursuing BCBA certification) or very new practitioners, they have many questions about Assessment. Such as, which tool to select for which client, pros and cons of each tool, what materials to use (particularly if the employer does not provide assessment kits), differences between assessing a younger child vs a young adult or adult, differences in assessing in the home vs community settings, etc. And of course, varying funder requirements will also influence which assessment tool is selected and even how much time is allowed to conduct an assessment.

In summary, the questions focus on "HOW". How do I pick the best assessment, for this client, in this particular setting, to gain the most helpful information?


Because at the end of the day, that IS the point of assessment: to gain valuable and salient information about the client that will guide programming and determine which goals to prioritize for treatment. 


Putting aside the specific options for a moment, the key characteristics of a quality client assessment will include the following: 

  • A variety of methods across both direct and indirect observation, interviews, checklists, tests, and/or direct skill probing to identify and define targets for intervention 
  • The priorities and areas of concern of the client, client caregiver/parents, or other caregivers close to the client
  • Record review of pertinent files or reports
  • Selection & measurement of goals
  • Problem behavior identification, measurement, and assessment

The assessment process is an absolute necessity to beginning treatment with any client. Regardless of age, setting, areas of concern, treatment model, etc., without proper assessment the intervention isn't likely to be effective or achieve true long-lasting change.

More important than the specific tool to select, is the ability to conceptualize treatment and prioritize goals. Assessment tools do have characteristics in common, and a big one is the assessor must already have an understanding and knowledge of capturing client attention, delivering the SD, prompting and prompt fading, data measurement, and conducting a thorough interview to gather important information about client functioning. For this reason, although some organizations will assign non-BCBAs to conduct assessments it is critical that the assessor (regardless of certification level) have the appropriate skillset and training to administer an assessment.

It is also important to recognize that the client's needs should guide assessment tool selection, and not just the tools that are available, the BCBA preference of tool, or other non-critical decision factors. Many organizations may only have 1 or 2 assessment tool options, which would then mean the clients served would need to be narrowed to the ones most appropriate for the assessment tools (e.g. if an organization does not have an appropriate assessment tool for early intervention, then early intervention clients should not be admitted). 

Lastly, let's not forget that completing a thorough assessment is meaningless if it isn't then connected to goal setting. What was the point of identifying barriers to learning, maladaptive behaviors, and skill deficits impeding daily functioning, if these goals never show up in the treatment plan? Or are never addressed in therapy? It is possible to overfocus on the assessment tool to the point that important, necessary daily life skills get neglected. For example: assuming that because a client has "filled" an assessment grid, they are now done with therapy/have no further need of intervention. 

If the assessment (when I use the word "assessment", I mean a combination of record review, interview, observation, and direct skill probing) identifies Gross Motor Skills, Manding, and Vocal Imitation as areas of significant concern, then programming for those areas should be reflected in the treatment plan. The absence of this, is often seen in "cookie-cutter interventions". Cookie-Cutter interventions can be recognized by their disconnect from the individual priorities or high need areas, and by their generic replication across multiple clients. While it is true that many clients with no prior intervention will present similarly (may share struggles with social skills or toileting), this is not the same thing as saying "Here are the 10 goals I select for ALL 5 -year- olds", or "Here is how I teach Toileting for ALL toddlers". If ABA is not customized and individualized, it isn't really ABA





 
*References - 

Cooper, Heron, & Heward (2014). Applied Behavior Analysis




*Awesome Resource - 











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