Many families are making the “center comparison” shortly after a child receives a diagnosis. They have a waitlist that needs to be filled by a certain time and funding authorization that will expire soon. Families are looking at “what is available close to me and can they take my child right away”. Often, the many factors that would help a family to make the best choice are not considered when choosing an autism treatment center in Newnan.
These questions may elicit quite different responses from diagnosticians, case managers, school-based personnel, and intake staff from programs, as families interact with each of these groups to receive some guidance about program comparisons.
Clinical approach, and how a center describes disagreement
Similar terms like naturalistic teaching and positive reinforcement have become more marketing-oriented. What a center actually does and how they go about things on a daily basis can be revealed when asking for procedures and how they are implemented.
One should also ask the program about their algorithm for choosing between Discrete Trial Instruction (DTI) and Naturalistic Environment Teaching (NET) and how they would decide to change to an alternative tactic based on data. How would a program handle escape-motivated behavior in a demand sequence? A program with a solid clinical model for programming can describe their decisions regarding such issues. A program with a poor model can only describe their values regarding such an issue.
Skill acquisition versus behavior reduction balance
It is also very important to find out how the program chooses to spend time between building new skills of children and reducing problematic behaviors of children. Typically centers with a great deal of time devoted to reducing behaviors do not have the assessment ability to identify the replacement skills that would comprise a child’s skill building program. Thus, it would be very beneficial to ask for data regarding how a center selects communication goals for non-speaking children and whether or not AAC is used in the program for early learning of speaking skills.
Credentials, supervision ratios, and turnover
Don’t confuse the BCBA’s board certification with the amount of attention your child will receive from his/her supervisor. Ask the center about the BCBA’s caseload size and what percentage of his supervision time is spent face-to-face with center staff as opposed to reviewing records of previously conducted programming.
- How many clients does each BCBA carry, and how many hours of direct oversight does each client receive weekly?
- What is the average tenure of behavior technicians, and what is the annual turnover rate?
- Does the center employ or contract with speech and occupational therapists, and how are goals coordinated across disciplines?
- What continuing education is funded, and is it tied to specific clinical gaps identified in supervision?
Turnover, Children will lose pairing time to new technicians many times within a year. Generalization data will be difficult to obtain. Families weighing their options among ABA centers in Rhode Island should ask each program to describe how they handle many technicians within a year and how much time each technician will spend reviewing the prior session’s records before your child’s session.
What an individualized plan actually looks like on paper
Ask to look at their actual treatment plans (with personal identifying information redacted, naturally) instead of looking at some center-made model or sample that they display on their website. One page of an actual treatment plan will immediately reveal whether or not a center is providing true, individually written programs for children or simply generic goals that are then copied and pasted into a form.
What is the starting point for the child? What assessment did they use to develop the goals for the child? What are the mastery criteria for each skill and are they the same for each goal? Are the generalization conditions listed for each objective? Do the priorities of the parents for their child get written into the objectives for the child (i.e. Sleep, eat with others, interact with sibling)?
Discharge criteria and hour recommendations
You should ensure that every child’s plan outlines what fading looks like. Centers can list the same amount of hours for all children and then decrease hours at a future date. But a clinically-based center runs off of a clinical model which increases intensity for skills not being learned.
Family communication cadence
Most family training is billed as a service, thus MEASURABLE. How often is training given? Who delivers it? How long does it last? Is it your supervising analyst delivering the training or is it delegated to someone else?
| Element | Weak indicator | Strong indicator |
| Progress reporting | Quarterly narrative summary | Graphed data accessible between sessions |
| Parent training | Scheduled ad hoc when concerns arise | Fixed weekly or biweekly slot with written agenda |
| Goal setting | Presented to family for signature | Family priorities recorded and ranked at intake |
| School coordination | Records released on request | Direct contact with IEP team, documented |
Reading the physical environment
You can even get a sense of a Center by their physical layout. How many calm areas are there to support children in the Center? Can your child acquire new skills in the open play areas or in more structured table work areas? Take a tour of potential Centers and come to see how they look at different times including peak hours of the day when children are attending. It will look very different from how it looked when you had an appointment with the family to discuss your child’s needs for autism therapy in Newnan.
Another factor to look for in assessing how well a program is going to deliver your child’s skills on a daily basis is the operational aspect of the business. The sound level, sight lines to children, condition of reinforcer materials etc. All will give you an idea of the thought process that the administration put into daily operations of the business. It is better to get a tour of the facilities at peak times of center operation rather than a quiet tour with the family to see the true delivery of services in an autism therapy center in Newnan.
Questions worth asking the front desk
- What happens when a technician calls out, and how often are sessions canceled?
- How are illness and toileting incidents handled and communicated?
- What is the current waitlist for the specific hours the family needs?
These operational differences are typically revealed by asking the front end of the office of 3 different centers and then comparing the answers given by the clinical leadership of the different centers versus the front end staff.
