ABA Services: Approved or a Sham? How to screen your ABA Service Providers

Considering ABA as a therapy approach for your child? Not sure whether the service provider you have chosen is verified? Your concerns are valid, in my many years of experience in the field I’ve seen and heard so many horror stories from parents and fellow clinicians.

Parents seeking ABA clinicians in Ontario and in any other jurisdiction where ABA is not regulated will be faced with a very challenging and daunting task to sort out the wheat from the chaff. So the question is, what can go wrong? All can go wrong. In fact, providers and clinicians can do a lot of damage, from the child not learning, to inadequate programming, to taking money from parents for treatment not provided, just to name a few. I put a list of screening questions parents can have in mind when they have already decided for ABA as a therapy approach.

THE PROVIDER

In the province of Ontario there is no process for approving providers. Providers can be people who decided to have a practice and opened a clinic or decided to open a practice that offers only home-based or both, home and centre based. Unlike daycares, there’s no checklist or criteria the providers must meet. The government or any agency checks on the provider of ABA. This can be very scary. Any food establishments have to comply with health standards yet in Ontario, anyone can open a centre for children with autism.

As a parent myself, I’d ask all of the following questions to THE PROVIDER:

1. Who is the owner of the practice? As silly as this may sound, you want to know who to hold accountable in case of anything going wrong. You shouldn’t wait for an answer or for an “I don’t know” Some background information is crucial, what’s the owner’s background? Name/last name? Do a quick google search. Find them on LinkedIn. Be suspicious if you find no record. Ask for references. Ask the community at large.

2. My next question would be about staff and the turnover rate. I wouldn’t want to have my own children in an environment that is not consistent where staff are coming in one door and leaving through the other. This speaks volumes of a business. I’d ask about the qualifications of the staff, does the business provide any training to the therapists? It is true that working with children with multiple challenges is difficult but there are many ways that an employer can provide healthier working conditions and work hard on staff retention.  

3. Next question is, how many children does the provider fit in their space at any given time? This question is applicable when it’s a centre-based provider. Remember that there’s no regulation as in childcare. A space where children can comfortably sit, play and share would be ideal. Winters in Canada can be brutal and movement breaks in children’s routine do help them focus and learn better.

4. How many washrooms for the number of children/staff? Why this question? Again, no regulation. Clinics can have no private washrooms which will make a toileting program very challenging when it comes to confidentiality. A shared washroom with other tenants of the building can compromise the confidentiality of the clients, can put vulnerable children at risk, particularly those boys are old and big enough to not be able to use the women’s washroom.

5. A question about cleanliness. A very good one to ask is about the frequency of cleaning the washroom(s). The more children/staff the more frequent the cleaning must be to prevent germs to spread. Children sit on toilets hence toilets must be sanitized for health reasons.

6. Ask about fees and how payment is done. If there are more than just one on one services being offered, you want to know if a breakdown of services will be provided to the parent. This information is extremely helpful to advise you of the services being provided.

7. Let’s talk cancellations. A centre-based related question. If your child’s therapist cancels, will your child be put in a dyad or a classroom-like setting? Will you pay the session as one on one? Will your pay be prorated based on the services given? I’ve seen private ABA providers charging as if one on one was provided yet the child was with 1 therapist and 3 other children.

8. Let’s discuss polices and procedures. The first one that comes to my mind is a complaint procedure. This is best practice agencies should apply. In case of a dispute, a serious occurrence you will need to know who to go to and this includes the BACB https://www.bacb.com/appeals/disciplinary-and-appeal-process/ or the college of psychologists http://www.cpo.on.ca/Plaintes.aspx?LangType=1033 in case of misconduct or simply the local police or Small Claims Court for funds related matters   https://www.attorneygeneral.jus.gov.on.ca/english/courts/scc/

The second one is a Privacy Policy. Best practice is to have a clear policy outlining how the provider protects the client information.

THE CLINICAL SUPERVISOR OR CLINICIAN IN CHARGE

1. The clinical supervisor (CS) may or may not be the owner of the practice, may or may not be the one supervising your child’s treatment plan, may be an employee or a contractual CS to the service provider. It is important to know who they are. Asking for a CV will allow you to see your CS’ training, practice and competence.

2. Ask about the caseload the clinical supervisor has. In other words, the number of children and the number of client hours the supervisor oversees. The BACB recommends two hours of case supervision for every 10 hours of treatment as being the general standard of care. If it is less than 10 hours of treatment per week, two hours of supervision is required.  https://www.bacb.com/wp-content/uploads/2017/09/ABA_Guidelines_for_ASD.pdf There are so many hours a human BCBA or psychologist can supervise per week! 

3. What about your CS delegates part of the supervision of your child’s treatment plan? Ask for a CV to see the qualifications, type of experience and schooling the supervisee does have.

4. Require you meet with the Clinical Supervisor. If you’re told a name for a clinical supervisor of your child’s treatment plan, you must meet the clinician. A BCBA has the ethical obligation to know the client and be involved in every aspect of the treatment plan. Don’t take a “they’re not available” as an answer. The clinical supervisor may just not even be aware their credentials are being used.  

My last word of caution has to do with how funding might be used. No regulation of ABA in the province of Ontario means no accountability. None. It means that many parents could potentially be victims of unscrupulous so-called clinicians, with or without certifications. I’ve seen it. Parents having no where to turn to for help means more vulnerable people being taken advantage of. Don’t let this be you.

I hope this write up will help you out in finding the right provider for your child’s treatment.

All the best!
– Andrea Rios (Phoenix Development Centre Founder & Owner)

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