What Can You Expect from ABA Services?

It can be overwhelming for a family when their child receives behavioral services for the first time. In the beginning, much is unknown, and it’s going to take some adjustment. 
 
Now imagine this situation: your child has just been diagnosed with autism or another behavioral deficit, and you’re provided with a list of applied behavior analysis (ABA) providers. You have never received services before, don’t know what the services entail, and are unaware of how this process should occur. Your ABA provider conducts an assessment of your child and requests 30 hours of direct services on the authorization report. The number of hours seems substantial considering your child is four years old, speaks in mostly complete sentences, engages in some mild tantrums (but what four-year-old doesn’t?), and mostly struggles with social interactions with peers and daily routines. So why the 30 hours?
 
To answer this question, we have to consider multiple factors such as age, functioning level, and family priorities. In the example given, the child is described as verbal with difficulties in socialization and following daily routines. The child would likely benefit from one-on-one behavioral services. However, is doing so the best option? Many providers don’t inform clients that different service models are available other than one-on-one direct therapist services. 
 
Different service models may include the following:

• Direct one-on-one services with a behavioral therapist 
• Group services (usually with peers within the same age group)
• Caregiver education/training

1:1 Services

Direct services mean the child is working directly with a behavioral therapist. This is the most common service model that ABA providers use. In addition to direct services with the child, a Board-Certified Behavior Analyst® (BCBA®) will usually work with the parent or primary caregiver on training and education of behavioral principles and the child’s goals. Although a caregiver may work with the BCBA® and treatment team on how to benefit the child, most of the time, services are being billed for the hours a therapist works with the child. 

Group Services

Group services are sometimes known as a social-skills group. This type of service is typically for individuals who can communicate more effectively with adults and peers but still show social deficits with sustaining conversations with peers, cooperative play, group transitions, and more. One important inclusion criterion for group services tends to be the absence of severe problem behavior (e.g., hitting others, running away) due to the structure of group services.
 
In group services, only one behavioral therapist may lead a group of 3-4 children, so if one child is showing aggressive behavior toward peers, it may be difficult for the therapist to focus on facilitating social interactions if they need to frequently block aggressive behavior. Another form of group services may be each child will have their 1:1 therapist with them in the group, but in a less intrusive manner (e.g., standing behind the child) to provide prompts. This is usually the case for children who have the verbal skills to interact but require additional prompts to interact with peers during the appropriate times. 

Caregiver Education/Training

This service model can go by many different names. It has been referred to as some of the following:

• Parent training
• Caregiver training
• Family training
• Parent education
• Parent consultation
• And more

This service model goes by many names, but for consistency purposes, this service model will be referred to from now on as caregiver training. So, what’s with the different names? Is it education or training? Well, it should be both. Caregiver training should begin with education about the child’s behavioral goals. Once the caregiver has sufficient knowledge of the goals, then comes training. 

This service model can sometimes be met with resistance from families. Common responses from families may be as follows:

• “Why are you working with me? Shouldn’t you be working with my child?”
• “Why do I (as the parent/caregiver) need to work on goals?”
• “I don’t have time for this.”

All these responses are valid. Parents are busy, and the big picture is to help the child, so why is caregiver training necessary?

At the end of the day, a child will spend most of their time with a parent or another caregiver, not a behavioral therapist. Suppose a child learns to follow instructions, engage in appropriate mealtime behaviors, play with others without problem behavior, but only in the presence of the therapist. In that case, these skills will not last when the therapist is gone. Have you, as a parent, ever asked, “Why will they do that for you, but not for me?” It is vital for parents to learn the behavioral strategies therapists use because it is more beneficial for a child to follow a parent’s instructions than a behavioral therapist whom they only see 3-5 times a week. ABA providers may be the experts when it comes to behavioral strategies, but the caregiver is ultimately the expert on the child.

After reviewing ten national ABA companies (services are provided in 4+ states) and speaking with local providers who work in-home, at a clinic, and at a school, here are some common themes regarding caregiver training:

• Participation is emphasized.
• Providers focus on training caregivers to the point of being able to implement the interventions themselves.
• It is a part of every plan and should be expected, or it is seen as an option when your child is receiving services, but it’s not mandatory.
• It may be incorporated into a service model such as the 1:1 model, but caregiver training alone is not an option.
• It may be listed as a resource but not as a service provided.
• A provider’s website may say that they use behavioral principles to support individuals with ASD and their families but don’t specifically mention formal training of any kind.
• It is unlikely marketed as a service on its own.

Caregiver training is rarely offered as its own service unless it is from an organization that does case coordination. So, what might a caregiver training model only look like?

The amount of time behavior analysts will spend with the caregivers is case-specific. Some cases may warrant an hour a week, whereas some may warrant three hours a week. When the caregivers are the primary client receiving services, the caregivers take on a more active role in service delivery. Initially, the BCBA® may work with the child to model strategies to use and then gradually fade the caregiver in to take over while providing coaching. Caregivers will often be asked to take data, implement procedures, and lead the sessions while the BCBA® is there to guide, answer questions, provide support, and ultimately fade themselves out. For many families who do not receive direct services for their child either due to various reasons (e.g., insurance, location, unnecessary for the child), a caregiver training-only model can be the type of services that caregivers want and/or need.

Caregivers may often hear that ABA providers are there to work themselves out of a job, meaning they want to get to a point where your child no longer needs their services; however, sometimes, caregivers still need a little bit of help and aren’t ready to be without services. So yes, one-to-one services are the most common service, but sometimes caregiver training is a more appropriate model to use.

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