Who, what, when, where, and why? These are the ‘five w’s’ that are traditionally asked when considering Applied Behavioral Analysis (ABA) therapy for a child with Autism and other developmental disabilities. Parents are often faced with a variety of options when they begin considering the therapeutic approaches, which may seem daunting. In-home services are often in high demand for busy families, as professionals can come to your home for treatment on your schedule. However, parents who opt for in-home therapy may not know what to expect and how they can ensure the success of this particular ABA therapy approach. The following describes the common procedures and processes that occur once the decision to begin in-home ABA services is made.
ABA Therapy Intake Process
The decision has been made to go ahead with in-home therapy. At this point, the preliminary Board Certified Behavioral Analyst (BCBA) will conduct an initial interview with the primary caregivers, those that are responsible for the child’s day-to-day care. During this meeting, the BCBA will ask questions about the child’s developmental history, their prescribed medications, previous services in ABA, speech and occupational therapy, and counseling. Additionally, they will inquire about problem behavior, such as physical aggression, self-injury, tantrums, or other non-compliant behaviors.
Then the discussion will shift. The ABA therapist will explain to the parents what it will be like to receive in-home therapy. Even in the event that a child with Autism has received another type of therapy before it may have for example occurred for only 30 minutes once a week. ABA is a very different change of pace and caregivers must be made aware of this.
Observational Evaluation for ABA Therapy
Herein, the BCBA will then gather information by directly observing the child in the home. They are there to take note of the child’s behaviors and caregiver responses to them. At this time the BCBA will also get a sense of the child’s daily schedule. Furthermore, they will begin to determine the factors that may be maintaining the child’s problem behaviors (e.g. attention from others, avoidance of non-preferred activities).
From there the BCBA will begin to place instructional demands on the child and present instructional stimuli. This will provide another layer to the professional’s understanding of the child’s capabilities. The BCBA will assess the child’s capacity to communicate with others and their ability to perform a variety of academic and social skills. Once these assessments are completed, the BCBA will then begin developing appropriate goals that will be the focus of the child’s treatment program.
Initiation of the ABA Therapy Treatment Program
When all assessments, interviews, and observations are complete, the BCBA will develop a team of Behavior Technicians to deliver the direct therapy. Finding a good match between technician and client is crucial. The decision will be based on the therapist’s experience working on goals similar to those identified during the information gathering process. The BCBA will review all information with the Behavior Technician, including treatment objectives and considerations for behavior management.
Finally, the Behavior Technician and BCBA will schedule a meeting with caregivers to discuss treatment goals. A weekly session schedule will be developed that will best suit the child’s and caregivers’ needs.
When a schedule has been agreed upon, the Behavior Technicians will begin working in your home during the scheduled times. The BCBA will then come to the home to supervise the program, make changes to treatment goals when needed, supervise the technician, analyze the client’s data, and ensure that all persons involved in the process are kept up to date on progress and program changes. Additionally, the BCBA will request parent meetings to discuss any new concerns, and the best ways to target continue skill acquisition with the family outside of therapy sessions.
Preparing for In-Home ABA Therapy
As a caregiver, you want to ensure that your child with Autism and their therapist feel comfortable and are properly equipped to conduct in-home therapy. Depending on your therapist’s needs you may be required to set-up an in-home therapy room or space. That means a space that is dedicated to therapy. When the therapist is not in session, they will ask that the child not have access to that room or the therapy materials at a minimum.
You may be wondering what the rest of the family should be doing while your child with Autism is in therapy? Don’t feel the need to lock yourself and the rest of your household in a room and stay quiet until the therapist has left. That’s unnatural and disruptive to the family routine. Though you may be free to observe the session, do not to interrupt or interject yourself in the session without the therapist’s input first. If questions or concerns about the therapy arise, please address them with the therapist afterward.
Remember, in-home ABA therapists have seen everything, from family arguments, parents crying to siblings throwing tantrums. There is no need to feel shame and embarrassment for the routine situations of your family life. It’s also important that you as the caregiver be available or home during therapy for ‘parent training’. That means not using the therapy time to run errands or go out for coffee with friends.
ABA therapists understand that a relationship or bond will form between your family and them. But there will need to be clear boundaries such as refraining from inviting them for dinner after a session or buying gifts as a thank you for doing their job. They are professionals trained to help you and your family succeed, as you grow alongside your child with Autism.
These are just a few of the ‘who, what, when, where and whys’ of in-home ABA therapy.