Why Is Family Involvement Important During ABA Therapy?

Most programs acknowledge that caregiver involvement and participation in their child’s program is important and enhances outcomes for their children. However, programs are struggling to determine what is realistic and sufficient participation on a session-by-session basis and what is too much for families to do. Ultimately, programs need to determine how best to use families’ participation to assist their child in maintaining new skills and generalizing those skills to all situations.

Generalization is the clinical argument, not a courtesy

In addition to increasing the number of people with whom a child can engage, increasing the number of settings in which a child can engage with others, increasing the number of items or activities with which a child can engage, and increasing the number of natural consequences that a child is exposed to, also increases the number of situations in which a child can use newly acquired skills.

Reduction targets can also inadvertently be increased by function-based interventions that are only implemented during the hours of the interventions and not at other times, such as dinner time.

Where teams tend to lose ground

Attending sessions of caregiver training does not mean that the parents are practicing new ways of interacting with their child outside of sessions. It is only by collecting treatment integrity data on the caregiver, by using the same procedural checklists as for the staff members, that one can find out if a plan has been translated into the natural environment of interaction for that family.

Structuring involvement so it is deliverable

Involvement fails for many reasons but most of all because it was vaguely specified. ‘Practice at home’ is not a target. A target for a caregiver can be specified in terms of a number of intervention procedures that he or she is to use. These can be specified in terms of number of times that he or she is to implement a number of different interventions (e.g. Three preference assessments and ten mand trials for mands for preferred items) on a number of different occasions (e.g. Four days per week). These can in turn be specified in terms of a particular time (e.g. Afternoon snack time).

Training caregivers in the skills of behavior modification, in the format of a Behavioral Skills Training (BST), is the most empirically-supported approach of training caregivers in how to modify the behavior of the person with autism that they care for. The key component of the BST approach to training caregivers is the rehearsal component, where caregivers practice, under the supervision of a trained therapist, the skills that they have been taught.

Matching the model to the family

The caregiver chooses settings, such as where their child’s target behaviors occur, who is present, and what their household can absorb. A single caregiver of 3 children and youth cannot sustain a 90-minute weekly coaching block but can complete high fidelity 5-minute embedded trials within the routine of the household’s daily activities. Families weighing local options are well served by a program such as ABA therapy in Quincy, MA that builds caregiver rehearsal into the weekly schedule rather than treating it as an optional add-on.

What families should probe when selecting a provider

Finally, the selection of a provider for your child is greatly influenced by the family. While searching for “aba therapy quincy ma” may seem like a simple task, it can actually result in a multitude of programs with different supervision ratios, hours of parent training, and discharge plans. None of this information is typically listed on the program’s website.

• How many supervision hours accompany each ten hours of direct service, and who provides them
• How caregiver training hours are authorized and billed, and whether they are protected when direct hours are cut
• Whether assent, dignity, and learner preference are addressed in written protocols
• How often goals are revised, and what data trigger a change
• What the criteria are for reducing intensity or discharging
• How staff turnover is handled, including overlap sessions before a technician change

Signals worth attention

Any program that cannot outline in detail how they plan to eventually fade out support for a child and their family (and treat parents’ questions with the same level of respect that they would treat attempts by a child to engage in inappropriate behavior) is setting up that child for dependence on services for the rest of their life.

Setting expectations across the first six months

Sequencing of the different phases of the treatment in a clear manner will also help families to avoid the wrong interpretation of slow early progress in the treatment of their child. Families who are well-informed as to what to expect in each phase of the treatment can best support their child in treatment.

1. Intake and assessment, including indirect and direct functional assessment, preference assessment, and a written baseline
2. Plan review with the caregiver, where goals are prioritized against family values rather than assessment order
3. Acquisition phase, with weekly graphed data and short caregiver rehearsal blocks
4. Generalization programming across people and settings, with fidelity checks on the caregiver
5. Maintenance and intensity reduction, planned before it is needed

Removing barriers rather than documenting them

Nonparticipation by family members can also be analyzed as behavior. As with the behavior of learners, typical controlling variables for nonparticipation by family members include work schedules that conflict with clinic hours, means of transportation, language of the family as compared to the language of the therapy, prior negative experiences with therapists or with therapy in general, and the effort required by the data collection for the various functions of the program.

By way of example, families may be able to manage having a single measure of behavior taken on a weekly basis. In other circumstances, families may need to have the protocols and data collection forms translated into the language of the family, and into the routines of the household. In such circumstances, caregivers can be coached during the same routines that are difficult for families. Therefore, families immediately experience relief from the difficulties that currently exist.

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