What exactly is Applied Behavior Analysis (ABA) Behavior Therapy Services? Straight from one of the most widely used textbooks, Applied Behavior Analysis Second Edition, ABA is defined as follows:
“Applied Behavior Analysis is a science devoted to the understanding and improvement of human behavior. ABA is a scientific approach for discovering environmental variables that reliably influence socially significant behavior and for developing a technology of behavior change that takes practical advantage of those discoveries”.
Some people may have already been exposed to ABA services that were either provided in their home, at school, at a center, or in the community, while others have never even heard of ABA. This post is meant to advocate for ABA and explain what an individual should expect from in-home services, However, this is not a guarantee that the company an individual chooses will in fact follow through with the recommendation being provided in this post.
Intake Process
Intake Forms will need to be completed by the client or his/her parent(s) which provide a company with personal information pertaining to the client as well as his/her family members; medical insurance information; current diagnosis (paperwork showing where the client received his/her assessment and diagnostic report); medical information and history; medications (if any); living situation; school (Is there an IEP?); other therapies being received (Occupational Therapy, Speech-Language Therapy, etc.); behaviors of concern; current strengths and weaknesses; favorite items and activities; etc.These forms will vary according to each company. Upon completing any form of this type, it is best to keep a copy and save it in a place where you will have access to it if ever needed in the future.
This is the time for the parent(s)/caretaker(s) to advocate for the client and ask as many questions to understand what that company has to offer for the individual who will be receiving services. Remember that if the client in under the age of 18 or is considered incompetent to make choices, the parent(s)/caretaker(s) are also considered the clients. Some questions may be as follows:
- What should I/we expect from ABA in-home services?
- What will behavior therapy involve and look like?
- Will those coming into my home to provide behavior therapy have experience and training or will they require on-the-job training?
- If requiring on-the-job training, how long will that take?
- What will be required of the parent(s)/caretaker(s)?
If someone tells you that someone else from that company like a BCaBA/BCBA will get back to you, be sure that they do. You are placing the client’s care in their hands.
Most importantly the client should be signing and dating any necessary consent forms such as: consent to collaborate with other service providers, to review previous programming from other companies, to provide in-home ABA services, for changes to treatment planning, for a functional analysis (FA), for a behavior intervention plan (BIP), and for any changes to the BIP, etc. It is highly recommended that a BCBA should not enter a client’s home and complete an assessment until the consent for services form has been signed and dated.
Upon scheduling the initial assessment make sure that you are receiving a Company Handbook for Clients/ Company Policy Handbook for Clients.
*If/when using medical insurance to pay for services, the company will require your medical insurance provider information so they can verify that your insurance does in fact cover ABA services. *This does not apply for individuals paying out-of-pocket.
**If you are transferring services from one ABA provider to another it is very important to do this at least 4 – 6 weeks before the previous authorization for services terminates. A company is only allowed to bill the insurance for so many hours/units toward assessment and treatment planning for the assessment and if a company goes over those hours the claim will be denied and someone will get stuck with a bill. Also, you must end services with a current ABA provider and notify your insurance company before starting services with another ABA company. Two different ABA companies cannot bill an insurance company for services at the same time. *This does not apply for individuals paying out-of-pocket.
Initial Assessment
There are two types of assessments known as indirect and direct and both are completed with a BCBA, client, and parent(s)/caretaker(s) with sometimes the assistance from a Registered Behavior Technician (RBT) or BT/RBT who is pursuing his/her BCaBA/BCBA. The in-home portion of the assessment will take about 2-4 hours depending on the assessments being used. Upon completing the in-home portion of the assessment, the BCBA will need to score the assessment(s), create a treatment plan according to the results of the assessments, complete a medical necessity assessment. and complete an assessment report with his/her recommendation and hours that are being requested. The BCBA should then schedule a meeting with the parent(s)/caretaker in order to review treatment planning, which should include all the programs, goals, and targets that the team will be working on with the client; parent goals with therapist; parent goals during parent training meetings; and parent goals & data collection to be completed after sessions; as well as reviewing the mastery criteria for behavior modification and reduction and a schedule for termination of services.
Introduction of Services
This is the time when the individual(s) who will be providing the direct behavior therapy will be introduced to the client and his/her parent(s)/caretaker. The Behavior Therapist (BT)/Registered Behavior Technician (RBT) should focus on pairing with the client and building a rapport with the parent(s)/caretaker. Pairing with a client should be done throughout each session in order to gain and maintain instructional control. As the BCBA observes that the BT/RBT is pairing well with the client, then some of the programs, goals, and their targets should slowly be introduced to the client. As the client is continuing to be observed and the BT/RBT is continuing to gain more compliance then more goals and targets will be introduced.
This is also the time when the team will be observing the client for maladaptive/inappropriate behaviors that could impede learning or could be a safety concern to the individual or others in his/her environments. Antecedent, Behavior, and Consequence (ABC) data will be collected on the maladaptive/inappropriate behaviors. It is very important for the ABA team to understand what is occurring before (Antecedent) and after a behavior (Consequence). A Functional Analysis (FA) may be required in order to implement a Behavior Intervention Plan (BIP), which would introduce new goals and targets to teach the client more appropriate and socially acceptable behaviors in order to still have their needs met.
As the client begins to respond correctly to the new goals and targets there should be a decrease in the maladaptive/inappropriate behaviors. Goals and targets should all focus on behavior modification according to the assessments that were previously completed and through continued direct observations.
Promoting Generalization and Parent/Caretaker Involvement
Parent(s) and/or Caretaker involvement is part of the process and must be carried out. As the client begins to make progress and is reaching their mastery set criterion for goals and targets with his/her BT(s)/RBT(s) it is important to make sure the client can generalize across other individuals so goals and targets will be implemented in order for the parent(s)/caretaker to work with the client during session while the BT/RBT observes, assists when needed, and collects the data for the parent.
The parent(s)/caretaker should also be provided with goals and targets they will be working on with the client outside of ABA and will be required to collect data for those goals and targets. Upon the BCBA implementing a new parent goal and targets, she/he should be reviewing everything with the parent(s)/caretaker, modeling how to perform said goal and target, role-play with the parent(s)/caretaker, and then have the individual rehearse it with the client. Also teaching the parent(s)/caretaker how to provide error correction with the client is a necessary step. The BCBA should provide the parent(s)/caretaker with data collection sheets and review how to collect the data. Typically, the BCBA will collect the data at the next scheduled parent training meeting so they can review the data.
Parent/Caretaker Training Meetings
A parent/caretaker training meeting may be scheduled for 30 to 60 minutes anywhere from once a week to bi-weekly. These meetings are scheduled for some of the following purposes:
- Review client’s progress with behavior modification pertaining to skill acquisition (goals and targets according to areas that presented deficits).
- Review client’s progress with behavior modification pertaining to maladaptive behavior reduction.
- Reviewing data and progress pertaining to parent/caretaker goals.
- Addressing questions and concerns that parent/caretaker has.
- Introducing new parent/caretaker goals.
- Introducing new materials to be used for parent/caretaker goals.
- Teaching parent/caretaker about ABA terminology and concepts.
- Observe the parent/caretaker working with the client and take data on a goal and target that was set up to specifically be addressed during this time.
Collaboration for Coordination of Care
If a client is receiving other services such as Occupational Therapy and/or Speech-Language Therapy, the BCBA should be collaborating with those other individuals who are providing the client with services. If the client is attending school, has an Individualized Education Plan (IEP), the school staff have concerns, and the parent(s) would like for the BCBA to attend the IEP meeting this is highly recommended that the BCBA do so if their schedule permits.
So, what is the purpose of collaborating with other service providers? This is not about one profession being more capable than another, this is about coming together in order to help the client make as much progress with behavior modification as possible so the client can be in the least restrictive environment. If one service provider is working on a goal and target in one way and another service provider is doing something entirely different this could influence the client’s behaviors. .
Transition and Termination of Services
A BCBA may transition services to another BCBA within the same company if/when the client is not able to agree with BCBA recommendations and programming OR indifferences are influencing the client’s progress. A BCBA may end services and refer the client to another service provider if the client is making little to no progress after three (3) months OR there are numerous cancelations even after addressing cancellation policy and problems with said client and the client is not adhering to the policy. A client has the right to terminate services at any time without reason.
We all know though that at some point services need to come to an end, however the good thing is, it doesn’t need to happen abruptly. This means that as a client is reaching their terminal goals and their maladaptive behaviors have decreased, the client’s data shows that over a set amount of time (i.e., 3 months) that the client is maintaining his/her progress and no new maladaptive behaviors have appeared that would impede learning and/or be a safety concern for the client and/or others in their environments, then services should slowly be faded out. The BCBA is responsible for providing a fade out plan and working with the parent(s)/caretaker to make sure that everyone is completing the scheduled transition from services and turnover to parent(s)/caretaker accordingly.
References
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis (2nd Ed). Pearson Education, Inc., Upper Saddle River, New Jersey 07458.