When a family has a child with special needs, they often are facing a critical decision within a short time frame (i.e. Within days or weeks) after a diagnosis has been given while wait lists for services are long. A family rarely has time to review a provider’s website and call for an intake, only to wait for an additional week or two for a tour, before signing off on a contract that will dictate the type of services and the amount of time their child will spend with a provider for the next several months. The information listed below represents key questions to ask, reasons for each, and items to review prior to agreeing to begin services.
Verifying clinical credentials beyond the certification number
Membership to behavior analyst certification bodies (e.g. ABAC, ABAI) is not sufficient. Does the Supervising Clinician hold current BCBA or BCBA-D certification? Is the Supervising Clinician licensed to practice as a Behavior Analyst in those states where it is currently licensed? The information regarding the Supervising Clinician’s certification and licensure is publicly available and the provider should be happy to verify this information for you with full names.
While it may be easier to read off of a website, families should really be focusing on the caseload of the supervising clinician and the structure of supervision for the RBTs on their child’s team. How many clients is the supervising clinician seeing? How many hours of direct supervision are RBTs on your child’s team receiving on a weekly basis? And how much of that supervision is in the treatment setting as opposed to being reviewed from recorded video?
Questions that reveal supervision quality
- What happens clinically when the assigned RBT calls out sick, and who covers the session?
- How often does the supervising BCBA observe the child directly, and for how long?
- What is the technician turnover rate over the past twelve months?
- How are technicians trained on a specific child’s protocols before their first session?
How much turnover is there among the RBTs? What % of staff have been there more than a year? A program with high turnover spends a large portion of billable hours re-establishing rapport with a child and re-teaching previously learned behaviors to new RBTs.
Distinguishing individualized goals from template programming
A treatment plan developed from a template will have similar goals for children of similar ages. The majority of these goals will be written using a discrete trial format to meet the needs of the child presenting with autism. Most importantly, there will be no reference to the goals and objectives listed in the treatment plan assessments completed by the family.
An Individualized Program Plan (IPP) should be developed from an assessment report that the family can read and understand and lists socially meaningful goals. For example, instead of just stating “comply” as a goal for increasing school work completion, a better stated goal would be “Increase completion of school work within 10 minutes rather than waiting until reminded by teacher.” Ask to see a redacted sample treatment plan and verify that each stated goal contains a) mastery criteria b) generalization criteria c) maintenance criteria.
Watch for goal selection that serves the provider
Look for goals that require high hour counts to complete or are frequently rewritten for reasons not well understood. Also, programs that only recommend the maximum authorized hours for all children are typically not in the best interest of the family even though they may be the default for many providers. You want to know the trade-offs of increased intensity and how the program would step down in hours in time.
Assessing how the provider treats parents as part of the team
It is important to determine how many hours of parent training are included in the authorized hours for services. Determine when parent training sessions are scheduled and what information the family can expect to learn from the training. Ask if the provider intends for the family to simply observe the therapy sessions with their child or if the family will learn to implement the same procedures with their child in natural settings.
Families weighing options for ABA therapy in Providence should also consider how much role modeling, teaching, and coaching of parents occurs in service of the child’s skill development in the home setting. Do caregivers simply observe sessions with their child and read descriptions of skills that will be taught? Are parents given a written copy of the procedures that will be used with their child? Will their child’s therapist use parent-led sessions with the parent as instructor and ABA therapist as coach?
Comparing service settings against the child’s needs
The setting or location for treatment is a clinical decision that is not based on convenience or on the provider’s ability to make appointments. Each setting has strengths and weaknesses and would be selected based on a variety of factors including the child’s treatment goals and his or her current level of tolerance for demands in the setting.
| Setting | Best suited to | Main limitation |
| In home | Daily living skills, family routines, generalization to the natural environment | Limited peer access, variable session conditions |
| Center based | Structured acquisition, peer interaction, controlled distractions | Skills may not transfer home without a plan |
| School based | Classroom behavior, academic readiness, staff consultation | Requires district cooperation and limited hours |
| Hybrid | Children needing both intensive acquisition and home generalization | Coordination burden, higher scheduling complexity |
For the physical setting of ABA services, observe the space in which services are delivered to children during their typical hours. Observe the staff to child ratio, the amount of noise in the environment, whether children appear to be engaged in activities or merely controlled, and whether natural reinforcement of desired behaviors is used or whether the use of mechanical reinforcement of desired behaviors appears to be the norm. Looking for a good provider of ABA therapy in Charlotte NC? Ask to observe the provider in the typical settings and hours in which they deliver ABA services to children.
Reading the data the provider produces
Any ABA program is going to collect data. It is less common for them to use that data for real change in programming. In evaluating service, families should ask to see reviews from previous months. The biggest factor to pay attention to is frequency of review. Most programs review every 6 months or so. Families can test the usefulness of data in their child’s programming by asking to see a graph from previous reviews and then what the clinician did in response to progress not being made.
What a functional progress review includes
- Graphed data per goal with a visible baseline and phase change lines
- A written summary of which goals were mastered, modified, or discontinued and why
- Any changes to procedures since the last review, with the rationale
- Updated recommendations on hours, with reasoning attached
- An agreed set of priorities for the coming authorization period
Reviews should generally take place within 6 months of the previous review. More frequent reviews are generally better. If a family is unable to obtain this information within a reasonable time (e.g. Within a week of a request), then there is a good chance that families are paying for hours of treatment and not getting any value in return.
