Caregiver's Guide to ABA

New To ABA?

One of two primary questions asked when caregivers are referred to us for Applied Behavior Analysis (ABA) services is “What is ABA?” and “What does it take to get started?” This process can seem overwhelming, but we are here to guide you every step of the way. 

Authorization and Assessment

Authorization, Assessment, and Treatment

Behavioral Achievements has created this guide to help those who are new to the field of ABA and help to understand the process involved in starting ABA therapy with a Board-Certified Behavior Analyst (BCBA). Times for ABA therapy vary based on the severity of needs per child. They can be a few hours a week, or they can range up to full-time (30 hours per week). Whatever the case, we work with caregivers to provide the best opportunities to provide their children the ability to thrive.

Authorization – Before Contacting ABA Provider

  • Primary Care Physician (PCP) or psychiatrist sends referral for ABA therapy to provider or guardian (FA11F).
  • Behavioral Achievements will contact the insurance and verify benefits.
  • Behavioral Achievements will contact Caregiver(s) to set up an appointment for the assessment.

How long does the Authorization period take?

  • Timelines vary by insurance company and can take 10 or more business days.

How to prepare for ABA Services?

  • Prepare with questions to ask the BCBA.
  • Write down or think of ideas of what you want out of ABA therapy.  If unsure, the BCBA will be able to assist you during the initial parent interview.
  • Prepare ideal times that you would like the assessment to occur.
  • Be prepared to set aside 2 or more hours for initial assessments.

Assessment – Beginning the process to determine what treatment will look like

  • A BCBA will meet with you and your child

Please make the following records available for review:

  • Diagnostic report
  • Any previous ABA treatment plans from other providers available
  • IEP, ARD, or 504 plan
  • FA11F (Autism assessment results)
  • Child’s Insurance Card

You will sign a form indicating that you consent to an assessment

The assessment will include the following components:

  • Parent/caregiver interview
  • Administration of assessment (forms for you to fill out)
  • Observations of your child
  • Interaction with your child

What to expect after/during assessment phase?

  • It can take up to two weeks for the BCBA to write goals and treatment plan necessary.
  • Approval period can be anywhere from 5 days to 15+ days
  • Signature of FA11E form (treatment plan that the BCBA writes)
  • Behavioral Achievements will go over explanation of benefits including hours approved/disapproved as well as dates that your child will attend therapy
  • If the child is approved for lesser hours, then the BCBA will discussion potential solutions on how to make up for those lost hours, if it is necessary

Treatment Phase

The BCBA and Behavior Technicians will be providing therapy through supervision and direct interaction. Your child’s progress is recorded through data collection and documentation. Caregiver signature is required on the session note/timesheet at the end of each session. You will participate in parent training on strategies and interventions used in therapies. The BCBA will report on the child at the end of the authorization period.

What can you do during the treatment phase:

  • The BCBA and Technicians may be questioned or asked about certain goals in addition to questions regarding the treatments being delivered.
  • Schedule Parent Trainings or meetings to learn how you can further implement things at home and different methods of intervention.
  • Caregivers may check in at any time during the session using the Hi-Rasmus login provided to each parent. This allows Caregivers to track progress and data recorded during the session with your child.

Behavioral Achievements Strategies and Methods

The following ABA strategies and reinforcement have been chosen to address each targeted behavior and are developed to address deficits relative to an autism spectrum diagnosis. Identified procedures used to carry out program implementation are obtained from evidence-based methods. Not all methods or procedures apply to every child since each behavioral plan is uniquely tailored to every client. In the event other procedures become more prevalent, this list will grow or reduce based on the pending evidence-based practices.

Antecedent (Proactive/Prevention) Strategies:

Environmental Engineering/Modifications: Craft an environment that harmoniously nurtures performance in unfamiliar surroundings. Eliminate distractions and ensure immediate access to rewards, fostering optimal conditions for success.

Visual Supports: Harness the power of visual aids such as schedules, scripts, and labels to activate desired behaviors. Let visual support guide the way towards increased engagement and comprehension.

Concise Language: Unlock the potential of clear, concise, and appropriate verbal communication. Tailor your words to the learner’s level, creating a symphony of understanding and paving the path towards achievement.

Pairing: Engage in a dance of delightful harmony by aligning with the learner’s favorite items and activities. Through shared enjoyment, become a beacon of positive experiences, signaling a wonderful journey together.

Transition Cues: Guide transitions from one activity or environment to another with grace. Deploy verbal, visual, or auditory cues, orchestrating a seamless flow for both mind and body to follow.

Prompting: Strike a harmonious balance by utilizing prompts at the right cadence. Gently guide learners, minimizing errors, and ready to gradually fade prompts, nurturing independence, and self-reliance.

Premack Principle: Utilize the Premack Principle to unlock the power of probability. Let high-probability behaviors become bridges to reinforce lower-probability ones. Paint a picture of “first this, then that” to inspire motivation and achievement.

Non-Contingent Reinforcement: Cultivate an oasis of non-contingent reinforcement, allowing access to rewards throughout the day on a fixed schedule. Nurture a landscape of positivity, where the promise of enjoyment awaits at every turn.

Choice: Unleash the gift of autonomy by providing opportunities for decision-making. Empower learners with the freedom to choose, igniting sparks of motivation and fostering a sense of ownership over their journey.

Interspersal Training: Conduct a beautiful symphony of skill acquisition with interspersal training. Present a composition that is 80% familiar tasks and 20% new challenges. Strive for a balance that harmonizes growth, mastery, and progress.

Errorless Teaching Procedure – Teaching Strategies

Incidental Teaching/Natural Environment Teaching: This approach involves incorporating the natural environment and utilizing everyday opportunities, as well as planned ones, to provide instruction. The instruction is based on the individual’s motivation and interests.

Discrete Trial Training: This method breaks down the targets into small and specific steps for instruction. Each step is presented in a structured and controlled manner.

Functional Communication Training (FCT): FCT focuses on teaching and reinforcing appropriate communication skills. It aims to replace challenging behaviors by eliminating the reinforcing outcomes that typically maintain those behaviors.

Modeling: In modeling, a person demonstrates the desired behavior to the learner, serving as a prompt and example for them to imitate and learn from.

Prompting: Prompting involves using cues, such as verbal instructions, gestures, demonstrations, or physical guidance, to support and increase the fluency of new skills.

Fading: Fading is the process of gradually reducing prompts provided to a learner to encourage them to respond independently. The goal is to promote independent behavior without relying on prompts.

Errorless Learning: This technique involves providing prompts immediately after instructions to ensure correct responses and access to reinforcement. It often uses shaping, which involves reinforcing correct responses and approximations of the desired behavior, gradually shaping it towards the target behavior.

Task Analysis: Task analysis breaks complex tasks into smaller, manageable steps or actions. Once the steps are identified, specific teaching procedures can be implemented to teach and guide the learner through each step of the task.

Shaping: Shaping is a process that involves reinforcing successive approximations of a desired behavior over time. It gradually shapes the behavior towards the target by rewarding and reinforcing behaviors that are closer and closer to the desired outcome.

Reinforcement Methods:

  • Token Economy: A reinforcement system in which tokens are earned for demonstration of target behavior and exchanged at a later time for reinforcement.
    • Tokens may take the form of stickers, tallies, coins, etc.
  • Differential Reinforcement of Alternative Behaviors (DRA): A reinforcement procedure which reinforces behavior that is an alternative to problematic behavior.
  • Differential Reinforcement of Incompatible Behaviors (DRI): A reinforcement procedure which reinforces instances in which the learner engages in a functional replacement behavior that is incompatible with problematic behavior.
  • Differential Reinforcement of Other Behaviors (DRO): A reinforcement procedure which reinforces instances in which the target behavior is absent.
  • Continuous Reinforcement (CRF): A reinforcement procedure which provides reinforcement for every instance or demonstration of a behavior targeted for increase.
  • NonContingent Reinforcement (NCR): Non-contingent reinforcement delivers reinforcement independent of the desired behavior occurring.
  • Positive Reinforcement: Providing access to a motivator immediately following the occurrence of desired behavior in order to increase the likelihood of the behavior occurring again in the future.
  • Negative Reinforcement: Removing an aversive stimulus immediately following the occurrence of desired behavior to increase the likelihood of the behavior occurring again in the future.

Consequence (Reactive) Strategies:

  • Response Interruption and Redirection (RIRD): An intervention that involves presenting demands or other types of distractions to interrupt and interfere with behavior and redirect it to an alternative response.
  • Representation of Demand: Tasks and demands are represented to the learner followed by a designated prompting sequence to maintain responding.
  • Extinction: An intervention in which reinforcement that was previously provided for problematic behavior is discontinued.

These strategies are not to be used independent of each other. Various interventions will often be combined for the best effect toward reducing and/or increasing desired behaviors. As your child meets the diagnostic criteria set forth by the DSM-5 for an Autism Spectrum Disorder (ASD) diagnosis, goals will continue to focus on the active ASD core symptoms and substantial deficits that inhibit daily functioning. This treatment level requires substantial support in a 1:1 setting while progressing to a restrictive environment and small group setting. A comprehensive or intensive treatment care plan includes 1:1 direct ABA, caregiver training, protocol modification and treatment planning.  A comprehensive treatment model has been shown to be most effective with the ASD population in current medical literature.

Services will be provided by either a Licensed Behavior Analyst (LBA), Board Certified Behavior Analyst (BCBA) or a Registered Behavior Technician (RBT). RBT hours will be supervised by an LBA, BCBA.