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Step 2: Seek Effective Treatment

 Questions to ask a potential provider:

 

 (1) What is ABA? 

  • ABA is the design, implementation, and evaluation of environmental modificiations to produce socially significant improvement in human behavior.

  • ABA uses changes in environmental events, including antecedent stimuli and consequences, to produce practical and significant changes in behavior.

  • The successful remediation of core deficits of ASD, and the development or restoration of abilities, documented in hundreds of peer-reviewed studies published over the last 50 years has made ABA the standard of care for the treatment of ASD.

(2) What experience should my BCBA or BCaBA have? 

  • The formal training of professionals certified by the Behavior Analyst Certification Board  (BACB) is similar to that of other medical and behavioral health professionals.  That is, they are initially trained within academia and then begin working in a supervised clinical setting with clients.

  • Training and supervised clinical experience with clients with special needs.

  • BCBA or BCaBA should attend ongoing Continuing Education Credits (CEU’s)  to maintain certifiction.

  • BCBA or BCaBA should be familiar with  and rely on peer-reviewed literature, established treatment protocols, and decision trees for the ASD population.

(3) What is caseload size recommendation?

  • Caseload size on average for a BCBA without support of a BCaBA is 6-12

  • Caseload size for a BCBA who has support of a BCaBA can be between 16-24

 (4) How often should the BCBA or BCaBA provide onsite supervision? 

  • The amount of supervision varies depending on individual client needs or insurance requirements.

  • 1-2 hours of supervision for every 10 hours of direct treatment is the general standard of care.

  • Tricare DEMONSTRATION program requires 2.0 hours a month for each tutor. This means that the BCBA or BCaBA should provide each tutor on your child’s team with an individual onsite 2.0 hour supervision session each month.

 

(5) What training should my paraprofessionals/tutors receive? 

  • Initial Training: Therapists/paraprofessionals should meet specific criteria before providing treatment, including background checks.  Before working with a client, a therapist must be sufficiently prepared to deliver treatment.  Initial training may include:

    •  HIPAA

    • Autism Spectrum Disorders

    • Developmental milestones

    • Data collection

    • Basic ABA procedures such as shaping, reinforcement, prompting, etc.

  • Ongoing Training: Therapists should receive direction on new goals or the revision of goals on a regular basis to ensure the quality of implementation.

  • There should also be ongoing observation, training, and supervision to maintain and improve the therapists’ skills.

(6) What should my treatment plan look like? 

  • An ABA assessment typically utilizes data obtained from multiple methods including:

    • Direct observation

    • Interviews with the client, caregivers, and other professionals

    • Data from standardized assessments (these assessments should be individualized for each client)

    • Problem Behavior Assessment

  • Your child’s treatment plan should not be based on only 1 tool (e.g. ABLLS-R or VB-MAPP)

  • The assessment tools will reveal areas that need to be addressed (e.g. fine motor, play skills, academics, self-management)

  • When prioritizing the order in which to address multiple goals, the following should always be considered:

    • Behaviors that threaten self or others

    • Behaviors that prevent student/family from attending normalized environments in the community or at school (e.g., self-injury or aggression, non-compliance)

    • Absence of developmentally appropriate adaptive, social, or functional skills (e.g. toileting, dressing, feeding, compliance with medical procedures) that are fundamental to maintain health, social inclusion, and increased independence

 

(7) Where should my child’s therapy take place? 

  • Treatment provided in multiple settings, with multiple adults and/or siblings will promote generalization and maintenance of therapeutic benefits.

  • Settings may include:

    • home,

    • school,

    • clinic,

    • places in the community

(8) What coordination of care should my BCBA or BCaBA do? 

  • Consultation with other professionals such as the school, outside speech, outside OT or PT helps ensure client progress through efforts to coordinate care and ensure consistency.

  • Treatment goals are most likely to be achieved when there is a shared understanding and coordination among all healthcare providers and professionals.

Step 3:  Discuss Your Child’s Diagnosis with the School

Navigating Special Needs Services