A caregiver over the age of 18 that you trust to care for your child should be home at all times while a therapist is in the home working with your child. This is important for several reasons. It is important to us professionally to keep the roles of the behavior therapist and caregiver distinctly different. Behavior therapists are in your home to provide behavioral skills training. If we take on a caregiver or babysitting role, we are not able to maintain our professional boundaries and our role changes. Behavior Therapists do not provide caregiving tasks to your child such as changing diapers, taking your child to the bathroom, feeding your child, or responding to any emergencies.
Our insurance at BTS of MN covers our therapist’s work that they do with your child just as if they were providing skills training at our office or as when you go to the dentist office and their professional insurance covers the work that they do. Additionally, our worker’s compensation insurance covers our staff should something happen in your home. However, our insurance does not cover anything outside of what is required for their work. Therefore, it is important for the safety of your child and our staff that they provide only professional services outlined in your child’s treatment plan and that there is a caregiver present in the home during therapy times. The caregiver DOES NOT have to participate in therapy; a caregiver must simply be somewhere in the home during therapy times.
Intensive Behavior Therapy services at BTS of MN should look like fun! Therapy will be conducted in your home or in the community during designated shift times. Typically, one Behavior Therapist will work with your child at a time. Therapists will be implementing programs with your child that correspond to his/her Individual Treatment Plan (ITP) in the areas of socialization, communication, and in reducing repetitive and challenging behaviors. We use positive reinforcement to increase desirable behaviors. This means we find things that your child likes to do and we reward their responses with these things. This increases the likelihood that your child will respond correctly again. This is the fun part! Most kids in our program enjoy the time with therapists and look forward to playing and learning.
Therapy is conducted in a space designated within your home, but we often move about the house. Trials, or short learning sequences are presented at a table using “stimuli” – or small objects/toys/pictures. We work very hard to ensure that children are engaged and motivated to work with the therapists.The Treatment Team is trained in teaching techniques that are essential to a program's success. ABA is highly structured and quantified. A key element to our program is taking objective and precise data to identify needs and to measure progress as targets, trials and objectives are presented and taught. This data is used to help make programming decisions, to document progress over time, and to modify the teaching approach when progress is not made.
Most of the research regarding ABA programs for children with Autism document success involving children who participated in between 30 to 40 hours of ABA on a year round basis for at least two years. Currently, no research has been published to identify the optimum level more precisely for varying levels of skills or ages.
ABA therapy services at BTS of MN follows current research regarding the most beneficial number of hours of therapy per week. This often involves an intensity level of 20-40 hours of 1:1 direct treatment to the child per week, in addition to 2 hours per week of family skills training with the caregiver(s). However, very young children may start with a few hours of therapy per day with the goal of increasing the intensity of therapy as their ability to tolerate and participate increases. Treatment hours are then increased or decreased based on the client’s response to treatment and current needs. Decreases in hours of therapy per week typically occur when a client has met a majority of the treatment goals and is moving toward discharge.
Although the recommended number of hours of therapy may seem high, this is based on research findings regarding the intensity required to produce good outcomes. It is also possible that time spent away from therapy may result in the child falling further behind typical developmental trajectories. Such delays will likely result in increased costs and greater dependence on more intensive services across their life span.Families new to ABA programs may wonder about the ability of a young child to "handle" 40 hours per week of intense instruction. It helps to remember that other children learning about the world naturally spend at least that much time playing and learning on their own.
Every child is different. Each of our programs are individualized to match the child and family’s needs. That means that each child’s program duration will be different. We recommend that families consider staying in the program until each Long Term Goal is achieved. These long term goals are again individualized for each child, and updated to reflect progress as the child makes gains. Some examples of long-term goals include the following: being able to engage in cooperative play with peers; having reciprocal conversations with others; playing with toys appropriately or not engaging in any aggressive or repetitive behaviors.
The child’s Treatment Team, consisting of parents/caregivers, a supervising mental health professional and a Treatment Supervisor, will collaborate throughout programming to make treatment decisions. This team will decide when treatment should end. Children are usually in our program for about 2 years.
BTS of MN implements treatment that has received the most research support regarding positive outcomes, but cannot guarantee treatment outcomes for a given child. Our goal is to provide intensive behavior therapy services for the amount of time necessary for children to participate more functionally and successfully in their environments including home and school. Many of the children in our program have gone on to participate in less intensive services following graduation from our ABA program to things such as Family consultation, outpatient therapy, social skills groups or speech therapy. Some research suggests that the autism diagnosis can be eliminated after successful participation in early intervention services (40 hours or more per week beginning before age 4). However, most children retain the diagnosis, but experience significant improvement in symptoms, allowing them to function successfully in a variety of environments.
BTS of MN provides home-based ABA programs. Some providers in the Twin Cities area provide services in a center-based setting, rather than in the family’s home. There are advantages and disadvantages to both home-based and center-based services.
The advantage to a home-based program is that your child, especially young children, can receive treatment in the place that they feel most comfortable. Parents/caregivers can also participate as much as they want in therapy and can watch therapy at any time and know what is happening. Parents also can know their child’s therapist and have access to ask questions. A possible disadvantage is that the family’s home becomes busy with therapists in the home up to 40 hours per week. A parent or caregiver also needs to be home while therapy is occurring.
The advantages to center-based programs include the availability of on-site staff, meaning that if a behavior therapist is sick or on vacation, there is likely another therapist on-site that is available to work with your child. All materials are provided and stored at that location. However, your child will have to spend time traveling to and from the center.
Our approach to ABA therapy encourages socialization by teaching children the pre-requisite skills they need to be successful in a social environment before putting them in that environment. When children lack the prerequisite social communication skills for peer interaction it decreases the likelihood that they will be successful in that setting.
Once these basic social skills are mastered in the home with the therapist, these skills are generalized – or the child is offered opportunities to practice their skills across environments. This is done by providing therapy sessions in community environments or with peers. For example, the behavior therapist facilitates a peer play date at home, then at the park, or the child and therapist attend the library story time or a community education class.
BTS of MN does not provide academic instruction. We encourage you to work with your school district to discuss options regarding homeschooling, changing your child’s Individualized Education Plan (IEP) to reflect an altered school day, or any other options they may have to help your child participate in a full or part time ABA program while still meeting School District and State guidelines and laws. School Districts are familiar with ABA programs and recognize their importance and need for intensity and are often able to provide you with help with paperwork or looking at options. If you need more information about school requirements, the Pacer Center can provide you with information and support. Their contact information is: www.pacercenter.org , (952) 838-9000.
Parents often wonder if their child will fall behind academically if they participate in a part or full time ABA program. We believe that children that do not yet have foundational skills to learn, such as: listening to teacher directions, attending, basic play skills, basic social skills to be with peers or that have behaviors that significantly interfere with their ability to be in a group and transition between activities, are likely not able to reap the benefits of academic instruction. We believe that we need to teach children these skills first, so that they can be successful and available to learn in that setting.
BTS of MN is similar in approach to many of the local providers of ABA services. When choosing a provider, we encourage families to ask questions and find a provider that is a good fit for your family.
We emphasize an individualized approach to programming that allows us to make sure we are working with each child’s individual strengths to improve on deficit areas. We use principles of ABA to tailor programming to each child. While we have a specific teaching sequence that is a basis for our Skills training it is grounded in research and is flexible enough to modify within programs, between programs, and for each individual child. Our work is grounded in the idea that if we are fun and engaging, your child will want to learn. We use reinforcement as a basis for our work; therefore, therapy with your child should look like they are having fun!
BTS of MN is unique in that we are the only local ABA provider that is also a comprehensive mental health clinic, offering a spectrum of services for children and families.