Setting up a home-based ABA (Applied Behavior Analysis) therapy program is no easy task. Even if your home-based program is smaller-scale—say, something you’re putting in place just to supplement what your child is learning at school or in a treatment program—you’re suddenly taking on the role of clinician and employer, all within your own home! If you’ve decided to set up a home-based ABA program for your child—whether as a primary intervention or as a supplement for other services–here are some tips that might help.
Are you ready to get started? Here are seven practical and effective tips.
1. Hire your Senior Therapist
This gets the number one spot for a reason: This is your first and most important step. Your senior therapist/lead instructor/head teacher/supervising therapist (you’re the boss—you get to choose the title you like best!) is the person that will oversee clinical decisions, curriculum development, and program quality. It is essential that this is someone you trust. Unless you are an ABA expert yourself, the quality of your program depends on having a knowledgeable and capable person in this role. The senior therapist can play a more or less active role in the program. Some senior therapists work therapy shifts with the child, others play only a consultative/supervisory role. If your budget is tight, hire a qualified person you trust, and bring them in for fewer hours per month rather than hiring an unqualified person to fill the role.
If you live in the US, one resource you can use when seeking a senior therapist is the Behavior Analysis Certification Board’s Certificant Registry, which will let you find Board Certified Behavior Analysts in your area. Just be careful: not all Behavior Analysts have autism experience or experience with home programs. You want someone who is comfortable not just with curriculum and clinical decisions, but also with training and supervising a team. In Ontario, Canada, the ABACUS List offers a similar service. Another cautionary note: clinicians posting on the ABACUS list may have wildly different levels of training and experience. Richard Saffran, a parent of a child with autism, has done an incredible service to the wider autism community by compiling a list of ABA Service Providers— not just in North America but throughout the world.
2. Hire Your Therapists.
Here’s another reason to hire a good senior therapist: she can help you hire your junior therapists/instructors, and—even better—help you train them. If you have a strong senior therapist, you can stay on budget by hiring green junior therapists, then training them in the way that best meets YOUR programming needs. Consider hiring students; when I was in graduate school I was so eager for hands-on clinical experience that I was practically willing to work for food.
When hiring, trust your gut: a lot of what makes a good therapist are intangible personal qualities. You and your senior therapist can train them in the hard skills of ABA therapy, but you can’t train someone in soft skills like enthusiasm, energy, and warmth. Have them interact with your child for a portion of their interview. Have your senior therapist model a teaching strategy and see if the person can take direction and implement it themselves. Go with your instinct; if you feel like they’d be a good fit, you’re probably right!
3. Connect with Other Families
Other families running home programs in your area are your most valuable local resource. They can help you with staffing leads and programming ideas. You can cooperate to do some joint programming. You can bounce ideas off each other, problem solve together, and share materials. You can even pool resources to invest in things that each family would not be able to afford on its own. When I worked in a home program, a small group of families would jointly hire specialists to provide training to their home teams together. We got to receive small-group training from experts from the Lovaas Institute and the Princeton Child Development Institute—what a dream for a new therapist!! What would have been prohibitive for each family alone was made possible by coming together and sharing resources.
4. Expect Turnover
Brace yourself–this is a high-turnover industry. With any luck you’ll find a senior therapist that will be with you for an extended period of time. But there’s a good chance that your junior therapists will be a revolving cast of characters. I’m not saying this to discourage you, but just to help you be prepared for the likelihood that your home program is never so much a finished product as a continuous work in progress. There’s a bright side to this though! New people coming in bring new ideas and breathe new life into a team. What’s more, it helps to prepare your child for the reality of an ever-changing world.
5. Hold Clinic Meetings
You’re hiring novice therapists and regularly bringing in new staff. You better make sure that everyone is doing what you’re paying them to do! Regular clinic meetings—either bi-weekly or monthly—will be your best weapon here. This gives your team a chance to discuss program concerns and problem-solve together. At least part of every clinic meeting should involve staff members modelling their work with your child. In addition to ensuring that everyone is on the same page, this also gives your senior therapist a chance to provide direct feedback on each team member’s instructional style.
6. Stay Involved
Yes, you need to be at those clinic meetings too. Particularly if your senior therapist’s hours with you are limited, part of the responsibility for quality control rests on you. Your team needs to see you as an authority figure—whether it’s around clinical decisions or other personnel issues like punctuality. Your senior therapist is your clinical director, but you are the CEO of this little operation! Your staff needs to see you in that way.
7. Think Generalization
Right from the start, it is important that your team views their goal as being meaningful instruction. Part of this means that every skill they teach needs to be generalized so that your child can apply it under a variety of circumstances. Don’t let them fall into a rut with their teaching: therapy sessions should be dynamic and varied. Set this as an expectation right off the bat. Community integration is really your friend here so get them out there: the park, the pool, the playground, the petting zoo, and the library can all be excellent instructional settings!
Good luck to you! If you have questions or would like see a topic addressed in an upcoming column, comment below or send an email.