How to: Find an ABA Program and BCBA to fit Your Child's Needs
You are beginning your journey through the diagnosis and waiting periods, and now you’ve been given the recommendation of Applied Behavior Analysis therapy. While this process is already feeling overwhelming, it just became more complicated! Many questions start running through a parents’ mind: “How do I know what ABA program is the best?”, “Is every place the same?”, “where do I even start?!”. Finding a provider can seem like an overwhelming and challenging task, but here are a few tips to help navigate the process.
When starting, it’s important to note, not every ABA center and/or Board Certified Behavior Analyst (BCBA) is alike! A unique way of looking at this process is by viewing it as an interview for the provider and the center. ABA therapy is not a one-size fits all approach and you will be spending a lot of time and energy at the center, and with your BCBA. Think of it as an investment. When you go on vacation, you spend countless hours finding the right place. The same goes for a car you purchase, or a home. And yet none of those are near the level of importance as this. Spend the time finding what is right.
You may ask, “How can ABA center’s be different?! Isn’t everyone doing ABA therapy the same?” In short: No!
Questions to Ask an ABA Program
What does the intake process look like?
This process may differ between centers and between BCBA’s and it’s important to ask what the process will look like for you and your child. The process should consist of an initial observation, parent/caregiver interview, and a behavioral assessment, which is completed by the BCBA. The behavioral assessment will include established instrument assessments and rating scales, such as the ABLLS (Assessment of Basic Language and Learning Skills), AFLS (Assessment of Functional Living Skills), VB-MAPP (Verbal Behavior Milestones Assessment and Placement Program), ABLA (Assessment of Basic Language Abilities), and/or Vineland Adaptive Behavior Scales. The BCBA will also be asking for copies of evaluations from other disciplines, i.e., (speech-language evaluations, physical therapy, etc.) (LaRue, R., & Bechner, L., 2009). After all the information is collected and the BCBA scores the assessment, the BCBA will then take the information and create an individualized treatment plan. The BCBA will review the plan with the parents/caregivers to ensure their input is incorporated into the plan, once the plan is finalized and signed by parents and BCBA, the plan then gets submitted to the insurance company and may take a couple of weeks before approval. The BCBA will explain the timeline for a specific start date for your child.
What tools do you use for assessing my child?
The behavioral assessment consists of a parent interview, behavioral observation of the child and the development of an individualized treatment plan. Data is collected through assessment instruments and rating scales, using the ABLLS, VB-MAPP, ABLA, and other evaluation reports from educational centers, SPL, OT’s and previous ABA evaluations (if applicable). It’s important that the BCBA is looking at more than just one assessment when creating your goals. Goals should also be individualized based on the specific assessments performed on your child.
What type of programming/ curriculum is implemented across the center and is it individualized per child?
Every child diagnosed with Autism Spectrum Disorder is unique and teaching strategies should be considered based on the learner. There are many different ways to teach children with ASD, and it is important to discuss with a provider, that more than one type of teaching strategy and data collection is being examined. “A curriculum that is pre-designed is often referred to as a 'cookie cutter' approach and should be avoided unless there is substantial scientific and data-based reasoning for its use under specific circumstances” (LaRue, R., & Bechner, L., 2009). No learner is the same, so the teaching strategies shouldn’t be either.
What type of collaboration do the other BCBA’s and Clinical Director have as a company?
This question is extremely important because as a field, it is vital for your child’s case to be peer reviewed by the Clinical Director and other BCBA’s. Case review meetings entail an overview of the child, their goals, and case conceptualization. The case review meetings should happen on a frequent basis, every week or every other week. Your child should be reviewed, within those case meetings, at least every three months to ensure goals are on track and progress is being made. If the child is having problems the BCBA should be seeking out supervision to identify new solutions. Case collaboration through review meetings are imperative to your child’s success. It is also important that BCBA”s with recent recertification’s are still receiving ongoing oversight and supervision. No matter how long in the field, every BCBA should be meeting on a weekly or bi-weekly basis with their Clinical Director to discuss their cases, help get questions answered, and receive support.
Important questions to ask a potential BCBA
Every BCBA comes with his or her own set of experiences, backgrounds, and different scope of competency. The BCBA’s past experiences and training will dictate their treatment planning, how they oversee your case, and how they interact with your family. Here are important questions to ask your BCBA or BCBA-D.
Are you a BCBA or a BCBA-D?
It’s important to verify that the person calling themselves a BCBA or BCBA-D hold the certification. An easy search can verify this! Find out by searching this website.
How many years experience?
Years experience may not be the only measure, but it does give some indication on how long the BCBA has been making clinical decisions and working with children diagnosed with autism spectrum disorder. Experience can also be measured in regards to number of clinical hours the clinician has completed for their education. BCBA’s must complete between 750- 1,500 hours of supervised experience working and completing their certificate.
How much direct experience do you have working with children similar to my child?
As a BCBA, the diversity of the field allows for a clinician to work with wide ranging learners, from young children to adults. The range can also differ in regards to differences and challenges among each age group. It’s critical for your BCBA to have experience within your own child’s age range and level of need. For example, the BCBA would not have enough first-hand experience to be competent working with a teenager when their only experience is working with 5 and under children. If a BCBA is gaining new experience within a different age range or learning new techniques within a specific challenging case, the BCBA should be receiving direct and indirect supervision from a more experienced BCBA or BCBA-D, that is working closely and monitoring competency.
Are there children you do not feel comfortable working with?
It is the BCBA’s ethical responsibility to understand their own strengths and weaknesses within their own practicing of ABA. A BCBA should know and understand their level of competency and their own limitations. If a BCBA is taking on a case they’ve had limited experience with in the past, it’s their duty to get additional supervision, or recommend another BCBA. For example, if a BCBA is competent in writing early learner programming, but has no experience writing programming for severe challenging problem behaviors, then it is the BCBA’s duty to take the steps outlined above.
References?
It may be necessary to request references from your BCBA. Like another job interview, talking to others that have previously worked with the BCBA will give insight into their practices, strengths, and weaknesses. Talking with other parents or professionals who have previously worked with the BCBA will help make important and informed decisions (LaRue, R., & Bechner, L., 2009).
How will I know the programs are individualized to fit my child’s needs?
The information derived from the assessments, the parent interview, and direct observation is where the BCBA will be gaining an understanding of the child’s strengths and weaknesses. The programs and/or curriculum should be modified to fit the learner. Similarly, the targets should be specific for your child and their needs. It is important to note some centers have pre-written programs that are not modified and put into the child’s plan without individualization. This type of programming is a “cookie-cutter” approach and should be avoided.
Describe the programs you would design for my child?
It will be important to ask for clarification and understanding of the specific programming the BCBA will be designing for your learner. You should expect the BCBA to include parents/caregiver concerns and goals into treatment plan design and programs. Every child with ASD is different, and their programs should reflect their own unique qualities.
How do you assess progress?
Progress should be assessed on a weekly basis, and you should expect updates on your child’s programs, weekly or bi-weekly from your BCBA. It is important that if progress is not being made, then the BCBA is modifying targets/goals to better fit your child. It is important to ask your BCBA how long specific skills should take and if progress isn’t being met, then understanding why. The BCBA should also be assessing barriers to treatment frequently and breaking down skills into more digestible sizes to better fit your child. Treatment plans and re-assessment of goals will happen every 6 months, where the BCBA will re-assess using the same instruments from the initial assessment. Your child is never compared to others, but only to themselves, and how they are progressing. You should be seeing socially significant change with your child. For example, even though a skill may be mastered in the data, if you as the parent/caregiver are not seeing progress and/or the skill is not meaningful to you, it is not a worthwhile goal.
How often will I be meeting with you?
The BCBA should be meeting with the parent/caregiver at least once a week. Parent involvement is crucial to progress, generalization, and maintenance of skills. Parents should expect to learn the same strategies, programs, and techniques within the child’s Behavior Intervention Plan and programs. Generalization is the transfer of skills to other relevant people, places, and materials; so even though a skill may be learned within a center environment, that skill needs to be transferred to the parent/caregiver within the home, community, and/or school environment (or wherever it most naturally occurs). Parent meetings shouldn’t only happen in an office without the child, but in fact they should occur within the child’s daily session. Parents should understand the techniques they are learning, the BCBA should then model the techniques, watch the parent do it and provide feedback to the parent. Hands on training is the most effective method for training skills and transferring techniques.
How often will you be supervising my child’s programs and treatment ?
The BCBA should be supervising your child’s programs and modifying targets every week. Depending on how many hours per week your child is coming to ABA therapy, the BCBA will supervise a specific percentage of that time. So for example, if your child receives 20 hours of ABA per week, the BCBA may come in for two hours each week. The supervision should consist of training the behavior technician on programs and analyzing the data collected for those programs. During this time, the BCBA should also be directly observing how your child is performing a specific skill and how they are progressing through their programs.
How will I be able to track my child’s progress?
Depending on the type of system the center uses to collect data (paper/pen or electronic), you as the parent/caregiver have the right to know how your child is doing on a weekly/monthly basis. If the center uses an electronic data collection system, then you will be able to get direct access, and log-in to see real time data. If the center is using a pen and paper system, then requesting goals and progress in a paper or graph format is an acceptable way to visually see how your child is doing.
What would a typical day look like for my child?
As a parent/caregiver, you will want to understand how much time your child will be working on 1:1 programs, social skills, and in group time. Time spent in a 1:1 setting may be important as the child is just beginning ABA therapy, but as time progresses, the child should be transferring skills to their natural environment and be working in a variety of settings.
How will we communicate about my child’s progress and meeting times?
It is important to understand how accessible your BCBA is, how and when to contact them, and how you will be communicating about meeting times. Asking these questions up front will help mitigate any confusion and frustration.
Will you be involved with other members of my child’s team outside of the ABA discipline (OT, SPL, School, doctors, etc.)?
This one seems like a no-brainer, but it is vital that your BCBA is in coordination of care with all other clinicians and professionals working with your child. Whether it is with school, speech therapy, or medical doctors, your BCBA should be in constant communication about goals, problems, and should find time to meet and observe your child in these other settings. Coordination of care between every discipline will help create continuity between each environment and builds for better success for your child.
Initial training and ongoing training for Behavior Technicians (BT)
The direct care workers will be the ones working 1:1 with your child and spending the most time with them. It is important to understand what their training is and how ongoing training occurs.
Do the Behavior Technicians (BT) need any type of certification?
In fact, the answer is no. A Behavior Technician does not need to have any previous training, but it is preferred. It is best if the BT is going to school to become a BCBA, or in a related field. Every ABA company should be doing extensive interview processes that involve questions to seek high performers who are excited for a challenge.
Are background checks performed?
Background checks are required for any person looking to become a behavior technician.
What does initial training look like for Behavior Technicians (BT) working on my child’s case?
Initial training for a behavior technician coming into an ABA company should go through company policies and procedures, be first-aid certified, and have both direct and indirect training with children where they learn ABA strategies and techniques. An ABA provider should have the BT’s going through extensive training, taking data on their skills, and assessing to see if they are competent in a variety of skills before working alone with any child. Training should be longer than a week and may take longer depending on how well the trainee is doing. Some skills take longer to learn and may require a longer training session.
What does ongoing training look like for the Behavior Technician working on my child’s case?
After initial training, the learning should not stop for BT’s working within the field. Every BT should continue to receive ongoing training, breaking down different skills to make sure they are competent in many areas. An ABA provider should also be providing the behavior technicians with monthly seminars to expand their learning and help them become more successful.
How many BT’s will be working on my child’s case at any given time?
This is an important question to ask because there should not be more than three behavior technicians working on your child’s case at any given time. Depending on the number of hours your child is receiving, the behavior technicians will have a schedule that is consistent each week. For example, if your child is receiving 25 hours of therapy, Monday through Friday, then typically, one behavior technician will come Monday, Wednesday, Friday and another Tuesday and Thursday. Keeping the staff consistent is key in 1) building rapport with your child and 2) makes for better communication and faster success for your child.
If I do have multiple staff, how will changes on my child’s case be communicated?
A communication system should be in place to make sure every behavior technician is being informed of changes. When new programs are put in place, the BCBA should be communicating those changes and training every behavior technician.
Do the staff have training on child dignity and ethics?
Staff training shouldn’t only include training on ABA skills and techniques, but also should include training on ethics and the importance of child dignity. Your child matters and training in this field should not be taken lightly.
LaRue, R., & Bechner, L. (2009). Consumer corner: Considerations when choosing a behavioral service provider. Science in Autism Treatment, 6(2), 5.
Baer, D. M., Wolf, M. M., & Risley, R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97.