*** Note: There are hyperlinks in this post ***
A previous post regarding this subject refers to both IBI (Intensive Behavioural Intervention) and ABA (Applied Behaviour Analysis). It should be noted that IBI was a term primarily used in Ontario. IMO, regional providers never explained the terms and autism service streams properly which has led to many misconceptions over what ABA truly is. The new Ontario Autism Program (OAP) does not refer to IBI and just uses the term ABA* going forward.
* For the purposes of this article, the term ABA refers to ABA therapy as opposed to the science of ABA
Back in June 2017, Minister Coteau announced the implementation of the Ontario Autism Program (OAP). A few things stand out:
- removal of age cap
- direct funding available to all families who prefer it (but direct service will still be an option)
- services up to age 18
Families have a choice between DFO (Direct Funding Option – funds are given to families to hire their own private provider) and DSO (Direct Service Option – services are provided by a regional agency). Note that the OAP replaces the AIP (Autism Intervention Program), ABA-based supports program and 8K/10K payouts. For more info about the OAP, go here.
Whether a family pays out-of-pocket or gets provincial funding (through the OAP via DFO) for ABA, selecting a quality service provider to oversee your child’s ABA program is an important responsibility for families.
NOTE: ABA practitioners are NOT regulated in Ontario. There is no regulatory college or body that imposes requirements, sets standards, ensures compliance, or issues discipline. While psychologists are regulated health professionals; BCBAs, BCaBAs and RBTs are not. Families are not really protected from unethical and incompetent providers. So, it is really important to do your due diligence
Here are some things to consider and questions to ask when screening potential providers.
Your child has a learning profile that is unique to them. A quality ABA 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. But, there are other standardized assessment tools (i.e. AFLS) that may be used as well depending on skill set, age, desired goals, etc.
- 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). Under the OAP, this would be the Behaviour 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 ABA 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
ABA 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 and the practical teaching methods of ABA. 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 to 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 ABA for young children with ASD. Information on who may make up your child’s team can be found here
Is there clinical oversight?
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. Under OAP DFO, clinical supervision may be provided by a psychologist or BCBA.
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.
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? 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 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?
If you intend on choosing DFO (direct funding option) under the OAP, there are clinical staffing requirements to take note of. You want to make sure that the provider you hire is eligible or is on their way to meeting the program requirements. Clinical staffing requirements are here
- Myths and Misconceptions about ABA
- Choosing a Provider
- Considerations When Hiring An ABA Provider
- Considerations When Choosing a Behavioral Service Provider
- What to Look for When Hiring an ABA Therapist
- Revised 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.)
- ONTABA Recommendations for Clinical Supervisor Qualifications in Applied Behaviour Analysis Programming for Children and Youth with Autism Spectrum Disorder
- ONTABA OSETT ASD Report | Evidence-based Practices for Individuals with Autism Spectrum Disorder: Recommendations for Caregivers, Practitioners and Policy Makers
Finding a therapist: