Choosing a Quality Provider

Once it has been decided that an intensive ABA program is needed, a provider for that therapy must be identified. In the Sacramento area there are many different providers. Bridges recommends that parents research the options available to them before deciding on a provider. Bridges feels that children need high-quality programs in order for them to maximize their potential. All programs must be measured by the success of each child.

Of course the child’s progress cannot be measured before program starts, so the program itself as well as the qualifications of the staff must be researched for parents to make an informed decision.

Any options being considered should be observed, whether they are classrooms or in-home therapy.

If you decide on an intensive ABA program we strongly recommend that parents view programs from various agencies before deciding which is best for their child. It is also helpful to seek recommendations from other parent or experts in the field, but in the end it is up to each parent to view all the options they are considering to decide which one is best for their child. It is important to remember that most parents have only had experience with a small number of programs, and some professionals and parent groups may have policies that prohibit them from recommending a particular program over another.

Some guidelines for researching the quality of different ABA programs can be found in our presentation "Some Considerations When Choosing an ABA Program for Your Child," for which you'll find a link at left.

Many peer-reviewed research articles have been published citing the components of effective ABA programs. Some of the features that effective programs had in common were:

1. Comprehensive individualized treatment addressed all skill domains.
2. A variety of behavior analytic procedures were employed.
3. Supervisors had completed advanced formal training and were very experienced with children with autism.
4. Parents were active participants in the program.
5. Treatment was delivered initially in a one to one format with gradual transitions to small and large group formats after extended periods of one to one teaching.
6. Treatment typically began in the home and was carried over into other environments such as the community, preschool, and kindergarten as the children developed the skills needed to learn in those environments.
7. Treatment was intensive, including at least 25-40 hours of structured sessions per week, took place for the entire year, and informal practice of new skills took place during most of the child’s waking hours.
8. Duration of treatment was typically 2 or more years.Children started at 3-4 years of age or earlier.
   (Howard, Sparkman, Cohen, Green, and Stanislaw, 2005, Lovaas, 1987, McEachin, Smith, and Lovaas, 1993).

All of the components listed above are part of Bridges’ programs.

Role of the Clinical Program Director

Each child’s program is individually reviewed and updated at least one to two times per month by a Clinical Program Director holding at least a Master’s degree, under the supervision of a board certified behavior analyst (BCBA). Every child’s program is therefore unique to that child, though all program components use peer-reviewed research based principles and procedures of applied behavior analysis. All Clinical Program Directors meet or exceed the requirements stated in California’s Title 17.

You can review a detailed description of Clinical Program Director Responsibilities here or from the Employment page.

Role of the Behavioral Consultant

The consistent implementation of all therapy procedures is crucial to the success of every child. Implementation for each child’s program is individually reviewed and supervised at least once per week by a Behavioral Consultant with at least a Bachelor’s degree and two year’s experience. Any other problems or other areas in need of attention are also examined by the behavioral consultant several times per month and are addressed on the spot or referred to the clinical program director as necessary.

Bridges's behavioral consultants have the expertise and experience to use a wide variety of research proven tools, including discrete trial, discrimination procedures, auditory language training procedures, functional analysis, functional skills training procedures, generalization procedures, and visually cued communication systems as appropriate for each child. If appropriate, Bridges' programs have the option of providing functional communication skills such as PECS (Picture Exchange Communication System) as a stepping stone toward vocal language.

All Bridges’ Behavioral Consultants hold at least a Bachelor’s degree and meet or exceed the requirements specified in California's Title 17 regulations. Programming decisions are never left to “lead” therapists or other staff who have not yet completed the requisite formal education and experience to design individualized programs.

You can review a detailed description of Behavioral Consultant Responsibilities here or from the Employment page.

Role of the Staff Therapists

The actual implementation of most of the hours of therapy will be done by staff therapists. These individuals must be trained both in general behavior analytic methods as well as the specific procedures used for each child’s program. Staff therapists implement all skill development procedures exactly as prescribed for each child. This includes with social praise and enthusiasm as directed, as we are teaching emotion skills as well as language and other skills. Staff therapists implement all behavior procedures for each child exactly as prescribed.

Before a staff therapist is assigned to a particular child, he or she must pass a paper screen, an initial interview with the human resource specialist, view two of the educational video tapes available in the office, pass a literacy test with a score of at least 85%, pass their TB and fingerprint screens, and pass a second interview with the consultant assigned to the case. The family is also given input to the selection of therapists for their child’s program. Once assigned, all staff therapists must complete a formal workshop, pass a workshop posttest, and 15 hours of training for each child they are assigned to (for existing cases) before they are allowed to provide therapy on their own without a supervisor present.

You can review a detailed description of Staff Therapist Responsibilities here or from the Employment page.

Other Considerations

When looking at an ABA in-home program or classroom you may also wish to consider the following:

• What kind of progress have the children made in this program?
• Is the program individualized? If so, exactly how?
• What are the qualifications of the people who are actually working with your child?
• How many hours per day/month/week/ does a person actually work with your child?
• Who decides what to teach? How does they know what to teach?
• What training is provided? To staff? To parents?
• Who will attend IEPs and quarterly meetings? What reports are prepared? When?
• What about special diets/vitamin therapy/ chelation/ pharmacological interventions?
• How much time (if any) is spent in group activities or without a person specifically assigned to your child?
• Is the time that staff members needs to take lunch breaks considered part of the child’s therapy time? What happens to the child during that time?
• What amount of data of taken? by whom? How often?
• Who analyzes the data? How often?
• What are the qualifications of the people who train the front line adults who will work with each child?
• What training is required of the front line staff who actually work with the child the most?
• What happens if a staff person leaves – what is done to train the replacement?
• Exactly how are parents involved?
• How is generalization of skills to other people and environments achieved?
• What happens if you are unhappy with a particular therapist or consultant?
• May you talk to parents of children in this program?

In some states, board certification as a behavior analyst is required to provide services such as intensive ABA programs to young children with autism. While this trend is growing, it is not yet universal. California currently does not require board certification as a behavior analyst to provide these services, however that status is now legally recognized by the State of California. All Bridges programs are supervised by at least one board certified behavior analyst.

In addition, The Autism Special Interest Group of ABA has adopted guidelines for consumers of applied behavior analysis services to individuals with autism, which you can read by clicking the link.

Resources

Behavior Analyst Certification Board: www.BACB.com

Cambridge Center for Behavioral Studies: http://www.behavior.org

Howard, Sparkman, Cohen, Green, and Stanislaw, H. (2005) A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.

Lovaas, O.I. (1987).Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Lovaas, O. I., Ackerman, A., Alexander, D., Firestone, P., Perkins, M., Young, D. B., Carr, E. G.,& Newsom, C.(1981). Teaching developmentally disabled children: The ME book. Austin, TX: Pro-Ed.

Matson, J. L., Benavidez, D.A., Compton, L.S., Paclawskyj, T., & Baglio, C. (1996). Behavioral treatment of autistic persons: A review of research from 1980 to the present. Research in Developmental Disabilities, 17, 433-465.

McEachin, J.J. , Smith, T., & Lovaas, O.I.(1993).Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 4, 359-372.

New York State Department of Health Early Intervention Program (1999). Clinical Practice Guideline Quick Reference Guide: Autism/Pervasive Developmental Disorders-- Assessment and Intervention for Young Children (Age 0-3 Years). Health Education Services, P.O. Box 7126, Albany, NY 12224 (1999 Publication No. 4216).

Smith, T. (1996). Are other treatments effective? In C. Maurice, G. Green, & S. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals (pp 45-59). Austin, TX: PRO-ED.

U.S. Surgeon General's Report on Mental Health - Autism Section (1999).

Page Updated 6 August 2007