Applied Behavior Analysis
Behavior Analysis is a practice based on the science of human learning and behavior. Behavior analysts believe that most of our behavior is learned and experiences shape human behavior. Behavior analysts believe in systematic application of treatment procedures and use of accurate and frequent data to validate treatment results. They believe that it is important to draw conclusions objectively based on observable and measurable behavior. Behavior analysts do not typically provide “talk” therapy unless they are also trained in that area. Therapy consists of active participation by clients as opposed to talking or processing about experiences. The goal of behavioral therapy is to produce positive and socially significant changes in behavior. Because behavior analysis treatment often requires effort, patience, and time, it can sometimes feel difficult. For example, when a child’s tantrums have been reinforced for months, when behavioral treatment is introduced, child’s behavior may get worse before it gets better. It is important that, once committed to a plan, clients and significant others carry out behavioral recommendations and always inform the lead therapist if for some reason they are unable to do so. When treatment is evaluated by a behavior analyst, he or she will assume that a client and his/her family are implementing it with integrity. Clients and their families should feel fully comfortable discussing any barriers to implementation. Honesty and trusting relationship are critical to the process.
What to expect after initial intake and screening?
The client is typically evaluated in their natural environment. The following assessment procedures are used:
Parent interview (family history, current concerns, goals etc.)- typically 1 hour
Client observation in different natural environments. These typically include home, school/daycare, and any other activities the client is attending- typically 1-2 hours.
If client is participating in other therapies, the behavior analyst will ask for consent to communicate with the other related services.
In-clinic standard assessment and observation- anywhere from 2-6 hours depending on skill level and complexity of behaviors. Caregivers typically do not participate in these assessments. In addition to skill assessment, these sessions help the therapist establish a relationship with the client
Service Authorization by your insurance provider (unless paying out of pocket)
Once the assessment is completed, the behavior analyst will prepare a comprehensive report, including functional behavior assessment for any problematic behaviors with which the client presents. This report will be submitted to the insurance company along with other forms required by client’s insurance. The behavior analyst will recommend a clinically indicated number of therapy hours as part of the service request.
Development of Intervention by BCBA
Once insurance authorizes services, therapy sessions can be scheduled. A Registered Behavior Technician (an RBT), who is supervised by the lead behavior analyst in implementation of the client’s programs, may begin working with the child. The first few sessions typically involve building rapport and pairing positively with the child so that the RBT establishes him or herself as someone the client looks forward to seeing. While the RBT builds rapport, the lead behavior analyst will develop 1. Treatment programs to address any skill deficits (e.g., in communication, social skills, daily living skills (e.g., toothbrushing), safety awareness, toilet training, bedtime routine etc.) and 2. Behavior plan to address challenging behaviors (e.g., tantrum behavior, self-injury, aggression etc.)
The lead BCBA will work with clients and caregivers to determine meaningful goals for each individual, including family members. It is impossible to guarantee any specific results regarding the goals. Collaboration between the treatment team and the family will increase the likelihood of treatment success. There may be ups and downs during the course of treatment and the variables that contribute to the downs may not be in anyone’s control (e.g., child’s unexpected illness). If the team feels that the therapy has become nonproductive, the lead BCBA can discuss the process of service termination with the client and his/her family and referral to other resources.
During a one-to-one direct therapy with the client- caregivers may or may not be present during sessions. If it is deemed that the child may have more difficulties or be distracted by caregivers’ presence, caregivers may be asked to wait outside in the lobby. Caregivers may choose to leave the premises but must provide the therapist with a phone number that they can be reached with and should not travel further than 10 minutes distance from the premises in case of emergency. If needed as part of client’s treatment and success in therapy, the therapists will collaborate with the family on the best model for how caregivers can participate in therapy (see caregiver training and support below).
Caregiver training and support
Behavioral treatment can also be provided in clients’ home, however, if this is the case, parents will be asked to fully participate. It is not uncommon for client’s behavior to be very different in the clinic vs. home environment. If caregivers and the behavior analyst agree and the therapist is available to travel to family’s home, treatment can be scheduled in the home environment and can include working through challenging behaviors, toilet training, and/or meal times. Caregivers will be asked to carry out any set programs or plans to address the issues outside of schedule home therapy time.
All caregivers will also be asked to participate in regular meetings with the behavior analyst (at least 1x month) to review client’s progress and trouble shoot strategies that can be used during difficult times at home and the community.
Who is on your treatment team?
Registered Behavior Technician (RBT)- the technician is typically a bachelor or master level professional who has completed 40 hours of ABA coursework, has been assessed by a behavior analyst, has passed an RBT exam, and has received RBT credentials from the Behavior Analysis Board, Inc. An RBT implements the programs; he or she may also develop programs under the supervision of the lead BCBA.
Board Certified Behavior Analyst (BCBA or BCaBA)- a bachelor (BCaBA), master (BCBA) or doctoral level (BCBA-D) clinician who oversees all aspects of client’s therapy. All programming decisions and recommendations must be approved by the BCBA. Caregivers are asked to direct any treatment questions directly to the BCBA to ensure use of proper expertise.
Sometimes the BCBA and the RBT will overlap and see the child together. The BCBA may visit while the RBT works with the child to provide supervision for the RBT and ensure that treatment objectives are implemented with integrity.
The ABA team at ATC has a collective 25 years of experience designing and implementing behavioral treatment across variety of populations and in a variety of settings. The lead BCBA, Dr. Anna Young, has over 18 years of experience practicing in hospital settings, private and public schools, homes, and day programs. As an Assistant Professor in College of Education, Dr. Young reviews current research and designs research projects in the area of behavioral interventions and caregiver supports of children with special needs, including autism.
Under behavior analyst’s code of ethics, the ABA therapists are not allowed to work with client or their immediate or extended family in any capacity other than behavior analysts, registered technicians, or consultants. Although the relationship involves very personal interactions and discussions, the relationship is strictly professional and not a social one. It is not appropriate for any ABA therapist to accept gifts or meals or be involved in personal activities, such as birthday parties, family outings, or family vacation. When therapists work at client’s home, the caregivers should not leave the premises at any time or ask the therapist to take the child to a different location that is not directly related to therapy goals.
Participation in Alternative, Non-Evidence-Based Therapies
ABA relies on objective data and evidence-based models. ABA practitioners respect that there may be ongoing research to prove that certain therapies that are not yet accepted as established or effective, may be deemed as effective in the future. The lead behavior analyst will appreciate your honesty in disclosing any additional therapies that have not been specifically prescribed by a diagnostic physician and that may be “experimental’’ in nature. This includes disclosure of medication and medication changes throughout the client’s treatment. Although the ABA team will not be able to implement any components of alternative treatment, the team can have an honest discussion with the client about any implications for participation in an alternative treatment and can help the client track progress using data. The ABA team will not support therapies that have been established as harmful. A list of established, emerging, non-established, and harmful treatments can be accessed at http://www.nationalautismcenter.org/national-standards-project
In the state of Montana, clients and therapists have a confidential and privileged relationship. ABA therapists will not disclose anything that is observed, discussed, or related to clients. Confidentiality has limitations, as stipulated by law and includes the following:
The therapist has client’s written consent to release the information
The therapist has been verbally directed by client to tell someone else about the particular situation
The therapist has determined that the client or someone else is in danger to self or others
There is reasonable ground to suspect abuse or neglect of a child or vulnerable adult.
A judge has ordered disclosure of private information.
Please, follow the ATC policy on attendance. It is critical that the client attends therapy regularly. Many of the goals and objectives of therapy rely on repetition, practice, and frequent exposure to learning experiences. If client misses a lot of appointments, progress will be adversely affected.