It’s important to know what an agency’s scheduling policies are ahead of time. I’ve been lucky enough to work with some fantastic scheduling coordinators, but this can still be a frustrating part of providing and receiving ABA services. If you’re receiving in-home services, you will have staff members driving around from house to house and things happen. Children and staff both get sick, unfortunately, causing some last- minute changes. Here are some questions you may want to check on ahead of time.
- How am I notified of my child’s schedule and any changes?
- How do I notify you of changes?
- Do you send substitutes if my child’s staff is unable to make it to a session?
Some agencies have staff members designated as substitutes, while others may fill in with whoever they have available. Whatever the case may be, you will want to make sure that person communicates with your child’s supervisor before they arrive, so they are familiar with your child’s programs.
- What happens when there are cancellations? Will I get a make-up session?
This often depends on funding. Some funding sources require that make-up sessions happen in the same week as the original session.
- How quickly will we be able to fulfill all my child’s hours?
If a child’s assessment recommends 25 hours per week, it may take a little bit of time for an agency to put together a schedule to cover all of those. You will want to know that there is a plan in place.
- How often do schedules and teams change?
Staff Makeup and Education:
Depending on agency and funding source, the makeup and experience level of your staff may vary. Each child has a supervisor or Board Certified Behavior Analyst (BCBA) overseeing the program, while a direct staff member will be implementing that program in the home. Some agencies have supervisors with a BCBA overseeing the higher level clinical piece and some just have a BCBA doing it all. BCBA’s are certified through the Behavior Analyst Certification board. For more information on what that entails, visit: www.bacb.com. The BACB also credentials direct staff with the title, Registered Behavior Technician or (RBT). Quality staff training is one of the most important pieces of a successful ABA program. In order to get a better idea of the experience level and kind of support your staff will have, you may want to ask some of the following questions:
- How much training does the direct staff receive?
- Is direct staff training both didactic and practical?
In addition to receiving in-office or online training, each staff member should have on-site experiential training with clients prior to beginning on a case.
- What kind of staff development training exists for direct and supervisory staff?
- How many RBT’s do you have on staff?
- Is any of the staff trained specifically in certain areas?
This is important especially if your child has specific needs. For instance, some children are particularly aggressive and may require staff with specific de-escalation and safety training.
- How many staff members will be on my child’s case?
If scheduling and hours allow, this number should be more than 1. It’s important for what we refer to as the generalization of your child’s skills. (i.e., each child should be able to demonstrate the same skill with different people). On the flip side, you want to watch out for too many staff members, such as a different person every day. This could slow progress, as it takes time for each one to get to know your child’s program and develop rapport.
- What is the staff turnover like?
- Are the supervisors all BCBAs?
- If you have non-BCBAs supervising, how often will BCBA oversight happen? How often will I see the BCBA?
- How often will I see my child’s supervisor?
You should see your child’s supervisor at least 2-3 times per month.
- How many cases does each supervisor or BCBA have?
This is going to depend on how many hours are provided to each of those cases, but typically, over 15, things start to get unmanageable. Closer to 10 or less is generally better for providing quality supervision.
Staff and Team communication:
In addition to education and training, it’s important that staff be supported and have communication with the whole team. The following questions may help ensure you know what to expect:
- What kind of oversight will the direct staff have?
The supervisor should be observing all the staff on their teams regularly. Sometimes scheduling prohibits this, but other arrangements should be made to ensure no staff goes without support. Your child’s supervisor should be there for your child’s first session and the first session for any new staff on the team.
- How often do direct staff members meet with supervisors? Are there meetings outside of session times?
- What is the process if I notice a staff member is not as strong as I’d like?
- Do you have team meetings?
Team meetings are meetings with your child’s whole team of direct staff and supervisor, preferably with the child and parent present. This is a great time to actually practice skills and work out any issues with the intervention that may arise. Team meetings have become a lot more difficult to schedule with certain funding sources, as most insurance companies do not pay for multiple people to work with a child at the same time, so agencies often can’t afford to do this. If it is possible with your child’s funding and agency, team meetings are a great way to ensure that everyone is on the same page.
Data and progress:
Data collection is central to Applied Behavior Analysis. Objective data recording is how we track progress and make programmatic decisions. Even if your child’s program is more natural in approach, it’s important that everyone on the team is running things the same way, otherwise that data could be invalid and your child’s progress impacted. The following questions will help you understand how you can track your child’s goals and progress, as well as how things are being taught.
- How is data collected and graphed?
- How can I look at my child’s data?
- Where are program instructions documented?
It’s really important that the supervisor writes specific instructions for staff on how to run each goal. It should be very clear exactly how each goal or program should be run. For instance, if I wrote a goal that simply stated a child should be able to identify 10 different objects, that doesn’t tell me how they are identifying them. Is that by naming them when asked? Is that by selecting them from an array of pictures? Different team members could be running this same goal very differently, which affects data and progress.
When looking for ABA providers, it’s important to know what services they offer as part of your child’s program.
- What kind of parent education is offered? What will this look like?
This should be more than having meetings with you. Your child’s supervisor should be walking you through managing behaviors and teaching new skills.
- Do you have social skills groups?
- Is it possible to schedule playdates with another client during session times?
- Can we do community outings?
- Do you coordinate with other service providers (e.g., school, OT, speech)?
Interventions/ Running of Session:
You will also want to be aware of what to expect in terms of interventions and flow of session. You may want to ask:
- What kind of teaching will be involved in my child’s program?
Some programs are more Discrete Trial Training (DTT), Natural Environment Training (NET), or a combination of approaches. No one approach is better than the other, but some may be more appropriate for one child or one goal than another.
- How are the goals developed?
- How are behavior interventions developed?
As a parent, you should be well-versed in your child’s behavior plan. For any challenging behaviors your child may have, your supervisor should have a clear plan with specific strategies for preventing the behavior (antecedent strategies), skills to teach to replace that challenging behavior (replacement behaviors), and specific strategies to use following the behavior (consequence strategies).
- Can I record sessions?
Sometimes you can’t be present for session or you may want to look back at things that occurred during session. You may want to record session for this purpose. Out of respect for everyone involved, it’s always good to let your supervisor know you are doing it.
- How many goals or programs will be run in a session?
The more trials presented of a particular target or goal, the more opportunities there are for your child to learn. The number of programs or goals run during a session will vary. There is no specific number, but for more straightforward programs, staff should be hitting several targets per minute. There are some programs that take more set-up (e.g., working on safety skills in the community or role playing social skills), but many programs can be targeted throughout session.
I hope these questions lend some insight to what quality services should look like, as well as things you will just want to know before beginning services. There are a lot of agencies out there, not all of the same caliber. The best thing you can do for you and your family is to educate yourself. For more information on what to expect in an ABA session, please read our article What is ABA Therapy for Autism? We also have parent education courses available, including our Introduction to ABA and Behavior Management Course for a more thorough understanding of how ABA works and how to implement specific strategies to help manage your child’s challenging behavior. I hope you find all of this information useful in making an informed decision.