A. Therapy:
How would you characterize your therapeutic approach?
Applied Behavior Analysts, LLC delivers top quality in-home intensive, post-intensive, pre-intensive, and diagnostic evaluation services to children on the Autism Spectrum. ABA emphasizes individualized goals based on proven, evidence-based treatment approaches - mainly Applied Behavior Analysis. We specialize in the delivery of Verbal Behavior Therapy, Lovaas, and ABA based interactive play approaches, matching the best approach (or combination of approaches) to the individual needs and learning style of the child.
How do you work with children who are nonverbal?
Children who are preverbal often need to develop many skills which build language and the ability to learn before verbal language will emerge. Working on developing a fun emotionally engaged relationship with a caring adult is often the first step. During this time we work on getting a child used to many sensory issues which cause distress and distancing from others. Children can learn to be responsive to their environment, follow non verbal gestures and cues and start to develop imitation skills. We also work on prerequisite skills for picture exchange communication (PEC's) and sign language.
How do you accommodate the child's sensory defensiveness?
Sensory defensiveness will lead to avoiding many learning situations. The first step is to understand a child's sensory issues. Once a child's sensory issues are understood and we have a good understanding of what movements, actions and activities a child loves we can start to remediate a child's sensory issues with a slow, caring, systematic approach. Arranging environmental events often will lead to a decrease of sensory issues. For example, if distressing sensory stimulation leads to positive movements, actions or activities a child's sensory issues will usually start to decrease. The fun activities will be predicted by the sensory stimulation and the feelings a child has surrounding the fun activity will transfer to the distressing situation making the distressing stimuli less distressing.
How do you deal with a child's aggressive behavior?
Aggressive behavior is usually a symptom of problems with communication. We would build on the child's abilities to communicate with PEC's, sign language or other augmentative means. Once a child has the ability to communicate, aggression often decreases. We may also have to include a systematic plan to decrease reward for the aggressive behavior with increasing prompts for the replacement communicative behavior.
What services are offered in addition to the in-home therapy (i.e., social skills groups, speech therapy, etc.)?
We provide diagnostic services, testing, individual and family therapy for anyone in need. Sibling groups, marital therapy, family therapy, social skills groups, sibling play groups are all provided as needed and appropriate.
B. Entering and Exiting the program:
Do you accept all children under the current Medicaid age limit who apply? If not, what are your entrance requirements, such as age or IQ?
We provide therapy services for all groups of people and all age groups. We have no IQ requirement for services. Everyone has the right to receive services to help achieve their goals or the goals they have for their family. We accept all insurance, medicaid, medicare and private pay. We will work with families to help them get the services they need.
What testing do you require initially?
Testing is based on individual need. Testing should never be a standard part of treatment unless it is going to help programming or treatment. All testing is based on the needs of the individual and the benefit that will come from testing. In general testing is used to help diagnose disorders, determine level of functioning in areas such as Intellectual functioning, language ability, or adaptive skills. Other assessments such as the ABLLS-R or the VB-MAPP can be used to help program for a child's developmental needs.
Under what circumstances will you accept testing by other agencies, such as schools or private therapists?
The purpose of testing is to answer questions that will lead to improved treatment. Testing from other professionals is always accepted. If the testing answers the questions necessary to help progress a child's program no further testing would need to be done at that time. Testing can also be helpful to document treatment effectiveness and should be used for such purposes when needed. In general the single subject design and visual inspection of data is preferred to document treatment effectiveness.
What are the current out-of pocket expenses that a parent must pay for the entrance testing?
Initial diagnostic assessments will be billed to insurance and medical assistance. Testing may be a part of the initial assessment or follow up assessment. If a family has medical assistance there would be no charge for the assessment beyond what is reimbursed by medicaid. A family who only has Insurance would be subject to their deductible and copay. All of these issues would be discussed with the family a head of time and an arrangement would be made to do testing for free if testing is needed but would be a hardship for the family. Most initial diagnostic assessments are done in the home and we do not charge for these assessments unless a child is already on the waiver. In such cases we would charge the waiver the standard fee for 1:1 services.
Can parents arrange to have these expenses spread out over a longer time period?
We work with parents to meet the needs of their individual case. Expenses can be spread over time.
How is the number of therapy hours determined?
The number of therapy hours is determined by the needs of the child and the family circumstances. Our main goal is to progress a child to optimal development. This often means 30 - 35 hours of therapy a week. Some higher functioning or lower functioning children may need more or less hours. There are state rules for intensive services which parents must be aware of. We work with the family and their individual circumstances to come up with the optimal number of hours for their child.
Do you require that the child may not be in any other educational programs when he begins therapy? If so, for how long?
Often a child is receiving other services when they begin therapy. Parents along with recommendations form professionals should determine the appropriate mix of services to optimize their child's developmental progression. We feel that usually 1:1 therapy approaches provide the best chance of progression. There are many cases especially with higher functioning children who have the ability to play with children where peer play activities will need to take precedence.
How is a child's progress evaluated, and how often is this done?
A child's progress is evaluated with standard ABA practices of single-subject-design strategies and visual inspection of graphs, standardized psychological testing, progression on the ABLLS-R or VB-MAPP or other appropriate measures to document developmental progression.
What are your criteria for a child exiting the program?
A child exits the program when they have reached maximum benefit from the program. When a child has good imitation skills and is learning through observational learning from peers and is motivated to be with and interact with peers they may be ready to start to transition out of intensive services and into more traditional learning environments. A desire to be with same age peers and the ability to understand subtle social cues and abstract social relations signals that a child may be ready for traditional learning.
Under what circumstances can a child be dismissed from your program?
Typically children are not dismissed from our program. Lack of followthrough that puts a child or therapists in danger may lead to termination of services.
C. Therapists:
What are the minimum educational requirements for line therapists?
Line therapists must have a high school diploma, a clear criminal and caregiver background check, and have the ability to understand behavioral principles and develop rapport with children. They need the ability to follow through with instructions and follow a consistent behavioral plan. They also need the people skills to fit into a situation where they are going into someone else's home and the flexibility to relate to many different people and life situations.
What kind of training are the line therapists given? Who provides the training and what are their qualifications?
We provide 30 hours of line therapy. Training is provided by Senior Therapist staff, the Director of Clinical Treatment and Dr. Lund. Classroom training involves learning the basics of Applied Behavior Analysis, collection of data and graphing, psychological ethics and avoiding dual relationships, professionalism, and confidentiality. The line therapist will then continue their training with a programmed sequence of readings and experiences supervised by a Senior Therapist with direct one on one training with a specific child for at least 10 hours. All Senior Therapists have 2,000 hours of line therapy experience and have gone through an intensive 16 week internship where they are mentored by the Director of Clinical Treatment or Dr. Lund as they work on specific cases.
What should parents do if they have a complaint about a line or senior therapist?
If a parent has a complaint about a line therapist they should document their concerns and bring their concerns to the Senior Therapist. Documentation with specifics is usually very helpful. We encourage all parents to tape sessions. Video tape of the therapists are also helpful. The Senior therapist will then decide with the parent and Dr. Lund what the appropriate course of action should be. If a parent has a concern or complaint about their Senior Therapist he or she should bring their concern to Chris Van Dyke or Dr. Eric J Lund.
D. Parents:
What kind of training is given to parents and other family members? How much training is provided?
Parents are trained to do individual therapy with their child. It is recommended that parents do a few hours of therapy a week with their child to be familiar with behavioral principles and the programs their child is learning. Parents are encouraged to be a part of team meetings and supplemental training provided by clinic staff or out side professionals.
Must one parent be in the home during therapy sessions? What alternate arrangements are acceptable?
In general we want one adult over the age of 18 who is responsible for the child's health and well being in the home while therapists are working with the child. This is important for generalization of skills and protection of the child. No one knows your child like you do and we believe it is important for you or your adult representative to be in the home while therapy is being done. We do everything we can to provide a safe environment for your child in therapy and the requirement of a adult caregiver in the home supervising is very important. We will make exceptions if a parent needs to leave for a few minutes to pick up another child etc. In these cases we would want to have the ability to contact the parent via cell phone if needed.
What, if any, support services, such as respite or counseling, are offered to families by your organization?
How are these services paid for? We provide counseling for family members and individuals. These services can be paid for through county funds, insurance, medicaid, medicare or private funding.
Do you provide prospective families a list of families who have used your services and have agreed to be contacted?
Families who are currently receiving our services are cover under HIPPA and confidentiality agreements set forth by ABA ethics and the law. Some families have offered to be available to families who want to speak to prospective clients. Families interested in talking to current clients can talk to one of these volunteer parents.
E: Other Agencies
How do you coordinate with area school districts that the children you are supporting attend?
We have staff who have education majors and advanced degrees in education who are very comfortable serving as liaisons to schools. We often have therapists or Seniors shadow children in school to help improve continuity of care between therapy and school activities. We are involved in IEP's when invited and often refer parents to advocates to help them with school issues when needed. We believe in fostering a relationship of cooperation with the school and other treatment providers.
How do you coordinate with private therapists that the family employs who are not a part of your organization?
Senior therapists and Dr. Lund often work hand and hand with other professionals. We are open to input and collaboration with a child's other professionals. We realize that many different professionals can add valuable insight into treatment directions. If suggestions can be integrated with a behavioral treatment plan without crossing ethical or professional boundaries we will often try to integrate suggestions.
