After receiving your child’s diagnosis of autism spectrum disorder (ASD), you probably felt a flurry of emotions. Perhaps you were shocked, thinking to yourself on the drive home, “but my kid talks.” Perhaps you were relieved, finally having confirmation that your sneaking suspicions about your child’s delays were valid.
Whatever you felt, you took the time needed to come to terms with the diagnosis, but then, then it was action time. You scoured the Internet, typing in phrases like “best autism treatment” or “autism cure?”
Somewhere within this search, you found Applied Behavior Analysis (ABA), the most scientifically validated treatment to reduce the symptoms of autism spectrum disorder (ASD) (links here, here, and here).
A treatment mostly covered by your insurance. A treatment you can receive in your home! You call ABA places in your area, have an initial assessment, sign a ton of paperwork, and then finally, finally, a trained specialist can start working with your child in the home. But now what?
Here are six tips to help you prepare for having an ABA therapist in your home:
1. 1+ people will now regularly be in your home
Your first question when starting in-home ABA is probably “who is this person?” Before signing on with a provider, it is best to do your homework and check your provider’s credentials (find an excellent guide for this here). All quality providers conduct thorough background checks on all their employees before hiring them. If you are unsure of your provider’s policy, you can always ask before agreeing to have someone in your house.
Now that safety concerns are out of the way, who is this person? You will likely have one or several direct-care therapists, depending on your child’s needs. The credentials of therapists vary widely by company and by state, but ideally, every therapist working with your child will be a Registered Behavior Technician (RBT). RBTs have received several hours of training in ABA and are closely supervised by Board Certified Behavior Analysts (BCBAs).
You should also be seeing your BCBA regularly in your home. A BCBA holds, at minimum, a master’s degree in ABA or a related field, and has passed a standardized exam to be credentialed. The BCBA should be there regularly to direct your child’s therapist and make changes to your child’s curricula and goals, as needed. The BCBA will be your point person for all your ABA-related questions in the home. If you do not regularly see your BCBA, this is a red flag, and you should contact your provider.
2. Establish house rules
It may feel odd to have another person in your home with you, even when you know the individual is safe and there to help your child. You can make the transition easier by establishing house rules with your therapist at the onset of services. First, are there any cultural or religious considerations? Cultural awareness is built into the ethical code of BCBAs, but being transparent with your therapists right from the start can be a huge help (1.05 C).
Second, are there any general house rules that need to be respected? Do you have a “shoes off” policy in your house? Does someone in the home have an allergy to be noted? Are certain rooms or parts of your home off limits for your child? As long as you are clear about your expectations, your ABA therapist should be more than happy to oblige by your house rules.
3. Be honest about video recording
Most providers agree that it is a legal guardian’s right to view ABA sessions. However, often, parents cannot be home when sessions take place. Recording sessions or viewing them remotely can be a good way for you to see what skills your child is working on, but you should let your therapist know you plan on recording the session beforehand. Although knowing about the recording shouldn’t change the way a therapist interacts with your child, the therapist may feel odd or untrusted, if you do not tell him/her you plan to record.
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4. Your therapist has rights, as do you
You and your child have many rights when you sign on for in-home ABA. In fact, every BCBA is held to a strict ethical code to ensure only high-quality services are being provided to your child. One thing that often gets overlooked, however, is the therapist’s rights. In fact, many providers do not have a comprehensive policy detailing their employees’ rights while working in-home. This can sometimes leave therapists in an awkward position and unable to advocate for themselves.
As a general rule, the therapist should not be harassed while working with your child, or asked to do things not in his/her job description (e.g., babysitting, working on unapproved goals, etc.). Your therapist should have access to a bathroom with a working toilet, toilet paper, and soap.
5. Therapists cannot accept gifts
Hopefully, you are happy with your in-home services, and your therapist has been instrumental in your child’s success. You may want to give your therapist a gift as a token of your gratitude, but this is expressly forbidden by our ethical code (1.06 D). In fact, most providers have a policy that therapists should not accept anything from clients, even a cup of coffee. Seeing your child’s progress is enough! (Also, we get a paycheck).
6. Your participation is valuable
At a minimum, a competent person over the age of 18 should be available throughout the session. This person should not leave the house while sessions are taking place, and should be available throughout (e.g., not in the shower, behind a locked room the therapist cannot access, on a phone call that cannot be interrupted in case of an emergency, etc.)
As to what you should be doing, this will largely depend on your child’s goals. Parent training is often included as an integral part of ABA services, as many peer-reviewed studies have shown that parent implementation of ABA can greatly help your child maintain skills (link here, here, and here).
In an ideal situation, you are an active participant in many of your child’s sessions, with the therapist or BCBA guiding you to implement behavior plans to decrease challenging behavior and increase skill acquisition. But, unfortunately, this is an unrealistic goal for many parents who work during session time.
If you are unable to devote a large chunk of time to overseeing your child’s ABA sessions, sit down with your BCBA and come up with a list of high priority goals. These should be goals that will have the biggest impact on your family. For example, if your child is working on identifying letters in the alphabet, following two-step directions, and brushing his teeth, it probably makes the most sense for you to work on tooth brushing with your therapist.
If your child has so much challenging behavior that you cannot take him/her into the community, you should probably start there. A good BCBA will always meet your family and your needs where they are, but if you want to be proactive and get the most out of your sessions, feel free to ask!
It isn’t easy to let a stranger into your home for several hours a week, but in-home ABA can have a hugely positive impact on your child. Of course, if something ever doesn’t feel right about your BCBA or the services they provide, you can contact the BACB to file a formal complaint. But in most cases, if you are open and honest about your family’s needs, your child will make huge gains.
This article was featured in Issue 91 – Great Back-to-School Strategies