Bridges Program Description
Most programs consist of four major components: assessment, workshop, actual therapy program, and transition to a less restrictive environment. The purpose of this type of intensive program is to allow the child to learn the skills he or she needs to be able to learn successfully in a less restrictive environment. We are rarely able to say what that environment will be at the beginning of a program, but we always aim for the highest achievement levels of which the child seems to be capable.
If you are considering a Bridges program for your child please contact the office and we will arrange permission for observations with some of our families. If you would like to see children of specific ages or with skills similar to those of your child please let us know and we will be happy to accommodate that with the permission of the families involved.
Assessment
Every prospective client must be assessed to determine if he or she is an appropriate candidate for an ABA program, as well as what skills should be addressed in that program. Bridges does a very thorough assessment of every new client, even if they are coming from an existing program. Most assessments will consist of approximately twelve hours of a Clinical Program Director working directly with the child to establish not only what his or her skills are, but to teach some new skills to assess an acquisition rate. An acquisition rate is a measure of how fast the child learns. Additionally, approximately three hours are spent with the Behavioral Consultant assigned to the case to assess functional skills such as toileting, eating, and dressing. Some of the functional skills assessment will be done by interviewing the parents, as the child may not choose to eat, etc., while we are there. All of the assessment is data driven, and parents are a very important source of data. We take what parents say about their children very seriously and recognize that parents know their children better than anyone else. Detailed descriptions of all parts of the assessment are provided in the parent packet sent to all prospective parents.
After the direct assessment work with your child is completed, a report will be generated by the clinical program director and reviewed by the board certified behavior analyst. This will be presented to the parents as soon as possible, and will be presented to the various funding agencies for the child’s initial meeting after the assessment. This report will recommend whether the child is an appropriate candidate for the program, and the specific objectives that the child’s program should start working on. These objectives are based on the skill levels the child showed at the assessment. We do not use a pre-set curriculum, as each child is unique and will need a uniquely designed program. We do have guidelines to make sure that all age appropriate skills are addressed. These guidelines are included in the parent packet. Click here to see a sample assessment report.
After the meeting, a training workshop specific to each child is presented.
Workshop
Bridges’s workshops are typically 24 hours long, spread out over several days. Most are scheduled on weekends to allow parents to attend with minimal disruption to their work schedules. Typically, the clinical program director will run one day of the workshop and the behavioral consultant will run the other two days. All therapist staff attend the entire workshop, as well as at least one parent. It is strongly recommended that anyone else who regularly interacts with the child (such as grandparents and caregivers) also attend. Workshops cover a great deal of information, and we will continue to train throughout the course of the child’s program during supervision visits. It is our philosophy that all the people who work with each child need to be well versed in not only what to do, but why to do it. We present basic behavior analysis theory at the workshop and on an ongoing basis so everyone knows the reasoning behind any given procedure we are recommending for each child. Of course, a great deal of time is also spent addressing the “what to do” – how, exactly, each lesson is run and how to make sure the child progresses as quickly as he or she is able.
Workshops cover each of the specific programs prescribed for the child. Other procedures such as discrete trial training, reinforcement, data, prompting, and discrimination (telling the difference between questions) are also presented to parents and staff. Additionally, workshops address how to teach the child functional skills such as toileting and drinking from a cup, and how to make sure the child uses these new skills in various environments under various conditions. If the child has been prescribed PECS (Picture Exchange Communication System) everyone is taught how to communicate with this method, and how to increase vocal language with PECS. Procedures to decrease inappropriate behaviors are addressed in detail as well at workshops. If the child has demonstrated behavioral excesses during the assessment and a functional analysis and/or behavior plan has been prescribed then time will be devoted to make sure everyone is able to implement those procedures.
There is a test for the staff members at the end of the workshop. Parents are welcome to take it, but do not have to pass. We use the tests primarily to insure that everyone has all the necessary information to work with your child.
Program
Immediately after the workshop the child’s program starts. All of the data books, stimuli, schedules, procedures, and other details are in place, and the child will actually begin his or her therapy. All children are different, but it is very common to see a change in behaviors almost immediately. Often there is a “honeymoon” period, where the child has far fewer behaviors than usual. Occasionally behaviors may increase. We use positive programming measures (never punishment) to teach every child appropriate replacement skills for his or her inappropriate behaviors as needed. Often children will increase their communication skills dramatically even at the very beginning of program. Some children take longer, especially if the child does not yet understand that if they do what we ask, he or she will be rewarded.
Programs typically last two to four years, depending on the needs of the child. Formal update reports are usually generated every three to six months to present to parents and funding agencies to summarize the child’s current skills and present recommendations. Click here to see a sample update report. We have found that as each child progresses parents usually gain very sophisticated behavioral skills as well. Typically children will incorporate structured peer play and community outings into their programs within the first year to 18 month of therapy. Usually a preschool placement is gradually introduced as part of the overall program at some point in the second year. Most (over 95%) of Bridges’s clients who are in school as part of their programs are enrolled in regular education classes with support. The support is provided by Bridges staff that work with the child at home and are able to ensure a very consistent level of expectation for the child across environments. Reinforcement, prompting, and fading procedures based on daily data are used in supported school placements just as they are in the home setting. Some children are in the process of fading that support. By the time school support is no longer needed in regular education classes, children are usually close to the end of their programs. Bridges does not make unilateral decisions about school placement for any child, but will recommend what we feel is in his or her best interest.
During the course of each child’s program supervision will be provided to the therapists working with the child. The recommended number of hours of supervision will be specified on each child’s reports, and typically include 15-20 hours of behavioral consultant supervision per month as well as 5 hours of clinical program director supervision per month. These hours will be used to watch therapy, insure that lessons are run correctly, insure that lessons are run consistently across all staff, trouble shoot, review all data, do whatever is needed to make sure the program is implemented properly, and run clinics. Clinics are weekly meetings run by the behavioral consultant for all the therapist staff and parents. Clinics give the team the chance to go over any changes in program, resolve any questions or issues that have arisen during the week, and clarify how to implement any new programs that may have been prescribed by the program director. The primary responsibility of the clinical program director is to review the data, observe the program, and make sure the child is progressing as quickly as possible. The clinical program director adds new therapy procedures to build on mastered skills as well as insure the generalization of mastered skills. Clinical program directors also will make recommendations when the child is ready for toilet teaching, structured peer, community outings, and possible school placements as part of the program. Clinical program directors design programs unique to each child as a need for each procedure is observed or indicated in the data. Examples of this may include a desensitization procedures for a child who seems to be frightened of certain items, or a unique visual/auditory prompting system for a child who experiences unusual difficulty with a particular language issue. Bridges uses a Skinnerian approach to language, which requires that the function of each language skill is considered. All supervision is provided by staff with years of experience in applied behavior analysis.
Training on each child’s program will be provided as needed if new people start on the child’s case. Typically this includes a workshop (parents do not need to attend) and approximately 15 hours of “doubling” with experienced staff on the child’s program, before “soloing” with the child.
Additional Training
In addition to the training provided specifically for each child’s program, training on specific topics is provided for staff members and parents. Approximately every three months a Saturday training on specific subjects is provided at the Bridges office, covering topics such as response form, school shadow support, how to run structured peer, reinforcement, advanced discrimination training, pacing, etc. Specific parent training is also provided typically at the end of programs for families who need further instruction on teaching their children with behavioral methodologies.
Bridges also sends some staff to outside conferences and seminars on a case by case basis.
Parent Training
Bridges provides training specific to parents as their children near transition if this is a need. Parent training presents practical, user friendly strategies for teaching new skills. Training also covers approaches to use for behavior problems that may arise after therapy is finished. This training is available at any point in the child’s program if the parent feels a need for it.
Transition
Intensive ABA programs are a long process, but at the end of program each child will need to transition to whatever his or her next placement may be. A very typical progression for children after their preschool years is two years of regular education kindergarten with support, then support for the beginning of first grade, fading to no support or school staff support at that point. Some children are functioning at grade level in regular education with no additional support as early as the end of preschool. Sometimes children may transition to a supported regular education environment with support provided by the school district, particularly if support is expected to be needed after first grade. Bridges has often trained the school support person and provided long term consultation support to that staff. Some children may be best placed in a special education classroom with varying levels of one on one time in their non-school hours, working on functional/adaptive skills. Some children have progressed so quickly that they no longer need intensive services and have lost their autism diagnoses completely before they start even their kindergarten years, or after only one year of kindergarten. Every transition is unique, and parents are a crucial part of the process of planning for transition.
Page Updated 1 August 2007