Considerations for Choosing a Quality ABA/IBI Program

What is IBI?

IBI stands for Intensive Behavioural Intervention. It is the application of the principles of Applied Behaviour Analysis (ABA) in an intensive, highly structured format. It is used to teach new skills and behaviours to children with ASD. An individualized curriculum is designed to improve learning in the key areas of cognitive, language and social development.

This link from Geneva Centre gives a good explanation of the two terms as they apply in Ontario. This is important to keep in mind when comparing services in other areas; especially the US where the term IBI isn’t used very often. It may be better to say that ABA is the science and IBI is one application of that science. But, the terms are often used interchangeably.

When it comes to autism services in Ontario, both IBI and ABA-based supports are available. All children with ASD (0-18 years) are eligible for ABA supports. This program is more of a parent training model and really should not be considered direct or intensive therapy (list of regional ABA-based lead agencies are here). Only children who are considered to be severely impacted by ASD and deemed eligible by their Regional Provider may qualify for funded IBI services under the AIP (Autism Intervention Program). But, please note that if your child does not qualify it doesn’t mean that they shouldn’t get IBI. It just means they are ineligible for the government program. If that is the case, families may look into getting IBI services done privately.

Whether a family pays out-of-pocket or gets provincial funding (through the AIP’s Direct Funding Option) for IBI, selecting a quality service provider to oversee your child’s IBI/ABA program is an important responsibility for families.
Here are some things to consider and questions to ask when screening potential providers.

1. Programming

Your child has a learning profile that is unique to them. A quality IBI program uses assessment results to inform curriculum targets. A behavioural intervention curriculum is broad in scope and targets a range of developmental areas.

What assessments are used to create a child’s Individual Service Plan (ISP)?*

Your service provider should use at least one of the following assessment tools.

  • Assessment of Basic Language and Learning Skills – Revised (ABLLS-R)
  • Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP)
  • Psycho-educational assessments

* Sometimes this is referred to as the IPP (Individual Program Plan)

When is the ISP provided to parents to review?

An initial ISP should be provided within the first 30 days of treatment.

Can parents add their input at an ISP meeting?

Parents should be encouraged to add input to their child’s ISP before, during or after the meeting.

What can be added to the ISP?

Parents can add anything to their child’s ISP that they feel is important to their child and family. This could be information related to short and/or long term goals. Some providers may incorporate parent input at the time of the ISP meeting, others may discuss goal setting before the ISP is created.

How will the program be individually tailored to meet the needs of my child?

Your provider should create an ISP based on the assessments conducted, direct observation and discussion with you. A program will be created that is based on a functional sequence of skills and fits with your child’s current level of functioning. The ultimate goal of this intervention is to increase your child’s rate of learning.

What domains or program areas are covered in the ISP?

  • The ISP is a comprehensive document. It will include programming across a wide range of curriculum areas. Programming will not just focus on one or two developmental domains.
  • Comprehensive developmental domains can include, but are not limited to the following: Attending, Functional Communication, Expressive Language, Receptive Language, Matching/Visual Performance, Fine Motor Skills, Gross Motor Skills, Imitation Skills, Personal Care Skills, Pre-academic Skills, School Participation Skills, Play Skills and Social Skills.

How often is the ISP updated?

ISPs should be updated minimally every 6 months

How do you manage and reduce challenging behaviour?

Your service provider should adopt a functional approach to address behaviours that may interfere with your child’s learning. These types of behaviours may be called challenging or inappropriate. This functional approach will include a baseline assessment to help determine if a more formal Behaviour Support Plan is required. Your service provider will conduct further assessments to help determine the reason why/function behind why your child is engaging in these behaviours. If a Behaviour Support Plan is required, it will focus on reducing the challenging behaviour as well as building skills. Prior to implementing a Behaviour Support Plan your consent will be obtained.

How do you include parents in programming?

Parents play a key role in helping their child generalize skills learned through IBI into other environments. Parents and service providers will work together to ensure skills learned in one environment are able to be demonstrated in other environments.

2. Data Collection

Do you collect data to assess my child’s performance?

Your service provider should collect data on a number of different areas including skills that your child is learning and has already learned. Data will also be collected on behaviour reduction.

How often are data collected?

Data should be collected frequently throughout the day/session

How are data used?

Data collected are used in order to help your service provider determine if what is being taught is being learned

How will progress or lack thereof be evaluated?

Your service provider should have documented revision criteria that will inform their decisions about how to adjust the program to ensure your child is learning at their best.

3. Provider information

IBI is a direct treatment. Research supports implementation by well-trained, well-supervised staff. Some providers hire their own staff, while others supervise/train staff that are hired by the family. Staff should be trained in both the theoretical principles of ABA and the practical teaching methods of IBI. This training should not be “one time” but ongoing professional development should occur. Staff training should also include mandatory reporting such as duty to report/CAS.

What experiences and credentials does this service provider have (years of supervised practice, number of individuals with autism served, types of behaviour treated, etc.)?

The people working directly with your child should have specific training, supervision, and extensive clinical experience in provision and supervision of IBI for young children with autism. Information on who may make up your child’s team can be found here

4. Supervision

Does a regulated health professional (e.g. Clinical Psychologist) oversee the program?

There should be a Clinical Director (or CIC = Clinician-In-Charge) who is responsible for overseeing, monitoring, and evaluating the assessments and ISPs. This person will also supervise and provide training to the Senior Therapists (STs) and Instructor Therapists (ITs) to support the overall quality and consistency of the behavioural intervention approach. The Clinical Director should have extensive clinical experience in IBI, have a doctoral degree in psychology, and be registered with the College of Psychologists of Ontario.

What is the frequency of live supervision with the child in therapy by the Clinical Director?

This should be a minimum of once per month.

What is the frequency of live supervision with the child in therapy by the Senior Therapist?

A minimum of once every week. Your provider should be able to adjust supervision to best meet your child’s needs.

5. Training

Please briefly describe your staff training model

Your service provider will describe a comprehensive training model that includes both new staff training as well as ongoing training.

6. Parent Involvement

Parents have an important role on their child’s treatment team. A service provider should offer parent training in a variety of formats.

Do you offer parent training? How often?

The service provider should outline parent training opportunities that cover information on ASD in general as well as child specific teaching strategies.

Are parents able to observe their child in IBI? How often?

Parents should be allowed to observe their child during a session. How this is arranged should be described by the provider.

How does the provider communicate with the parents?

The Service Provider should have practices that involve regular communication with the family. This may be in the form of a regularly scheduled phone/face to face meetings or a Daily Communication Book that is filled out by the IBI staff. Daily communication may include successes, challenges, changes made to the program, and any observation/comments that may be useful for the family. In addition, next visit dates by the Clinical Director and Senior Therapist are noted.

7. Procedural Questions/Intake

  • How do you apply for admission into your program?
  • Do you have a waitlist?
  • Will there be an intake interview to determine eligibility?
  • What are the costs of the program?
  • Are there costs not included in the service agreement?
  • Do you charge extra for each updated curriculum assessment?
  • What the fees cover in terms of services provided?
  • Do you offer part time placement?
  • Is the cost of materials covered?
  • For in-home sessions, am I expected to be present while service is occurring?
  • Will you attend school meetings and provide consultation to staff?
  • What is your cancellation policy?
  • What is your termination policy?

Other resources:

Myths and Misconceptions about ABA

Considerations When Hiring An ABA Provider

Qualifications of Behaviour Service Providers

Consumer Guidelines for Identifying, Selecting, and Evaluating Behavior Analysts Working with Individuals with Autism Spectrum Disorders

Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers (2nd ed.)

Finding a therapist:

ABA Recreational Resources

ABACUS

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s