With so many different approaches and programs out there, it can be extremely difficult to decide what program is the best match for your child. In addition to a program’s efficacy parents and professionals need to make sure that there are no fundamental differences regarding a child’s treatment. The BCBA is the professional expert and she/he comes to the table with a lot of knowledge. But, parents may have specific fundamental believes regarding their child, and a clear discussion needs to take place where expectations on both sides are outlined and a common ground is found before the onset of the program.
Here are 10 things we found to be extremely important to talk about with a potential client during our initial meeting:
1.) Who completes the assessment?
Usually the BCBA completes the assessment, and based on the assessment results the intervention program is outlined.
2.) Who implements the program?
In order to accommodate this, the ABA model has a unique structure similar to a pyramid. At the top of the pyramid is the BCBA who designs the program and supervises the progress, data trends, and behavior plans. In addition, each child has a team of therapists who are trained to implement each child’s programs, and behavior protocols. They work under direct supervision of the BCBA, and are the ones who work directly with the child for the majority of hours.
3.) Can you explain reinforcement?
Reinforcement is one of the most important procedures used in an ABA session. We use reinforcement/reinforcers to increase appropriate behaviors, and to facilitate skill acquisition. There are 3 main categories of reinforcers that can be used: edible reinforcers (food and drink items), toys (can vary from cause and effect toys to thematic toys, board games, etc.) and gross motor activities (tickles, chasing, etc.). A program may be using just one or all of these reinforcers and parents need to make sure that they agree with the BCBA’s recommendations.
4.) What is the ratio for patients to therapists?
During intense acquisition phase ABA is most effective when provided in a 1:1 ratio meaning that the child works directly with a therapist for the duration of the session. This is an important question to ask as sometimes, programs design sessions in 1:2 formats. In this format, the therapist is assigned 2 children for a session, and takes turns working with one child at a time. This is a less effective way to learn as child A is taking a break while child B works with the therapist. Each child still works directly with the therapist, but the time is split between the two children and depending on various factors, such as maladaptive behaviors, duration of programs, etc. the time may not be equally divided between clients.
5.) Can you break down self-stimulation?
Self-stimulatory behaviors are repetitive behaviors that some individuals engage in to gain access to various types of sensory inputs. Generally, there are three main points of view regarding self-stimulation. A) It will decrease once more skills are acquired therefore no specific intervention is needed; B) It serves a self regulation function (the child engages in self stimulation as a way to regulate sensory input, emotions, behaviors, etc.) and it should not be addressed at all; C) It interferes with skill acquisition and generalization, and interventions need to be implemented to decrease self stimulation and replace it with more appropriate, functional ways to gain sensory input and self-regulate. Different BCBAs may choose one of these approaches, or may combine them depending on each child’s individual needs.
7.) What about peer interaction?
Peer interaction should be part of an ongoing program but the onset of peer sessions should be carefully planned out, and started only when successful outcomes can be achieved.
8.) Can you tell me about parent involvement?
Parent involvement requirements should be discussed with the BCBA before the onset of the program. Some parents prefer to be involved in the skill acquisition while others prefer to work on generalizing skills after they have been learned in therapy sessions. We do recommend our parents to learn and implement behavior protocols to be able to handle different situations, as well as to work on skill generalization.
9.) Administrative questions
They may not be on your mind when you are looking at a program but make sure you know how many sick and vacation days are allowed before the parents are required to assume financial responsibility for missed sessions.