After my
long whine about running a home program, I thought it might actually have been better if I had posted about how to start one and other helpful tips for parents new to all this.
Mind you, we are also new, because we have only been doing this for almost three years now. There are parents who are now in their 5th or even 9th year of home based ABA programs.
There is a
great website that does a much better job of this, you can skip this post entirely and go there. I am going to however post my personal experience.
A self-funded program (i.e. one without government assistance).
Find a Senior Therapist.
This is the backbone of your program. They should be Board Certified. BCaBA (or Board Certified Assistant Behavior Analyst) is one level below a fully certified BCBA. The difference is just in the hours of supervision they received. Honestly it doesn't matter that much in my opinion. You can find out more about this certification
here.
There are many many bad Senior Therapists circulating in the GTA. I have seen some horror stories, and horrible programs. How will you be able to find the right person?
References are not enough. Anyone can get a good reference. When checking up on a Senior Therapist go through some of their existing client's programs. See a session in progress. Invite them over and watch them interacting with your child. Demand these things. At a rate of $80 per hour (and rising in this market) its the least they can do.
ABA has moved on since the Lovaas days. Find out how many verbal behavior programs your therapist has done. Has she attended any workshops? Who supervised and trained her?
It is easy to make a fake resume. For that much money, people are doing it, and they are ruining the lives of children.
Word of mouth is the best way to find a good Sr Therapist. Advertise on the various yahoo groups like
AutismOntario or
abatherapyontario. ( go to groups.yahoo.com and enter these group names in the search field). You can also go through the
Abacus List website and call the ones who have written down supervisor next to their name.
I stayed away from centers because to me it was a black hole. Once I drop my kid at the door I don't know what is going on in there.
I have had therapists working for me who have told me that centres they worked for would make them work with groups of kids and lie to parents that the child got 1 to 1 therapy.
I know a few senior therapists and some centres that everyone in the GTA should run far away from. Email me, and if I trust you, I will tell you who they are :D
Finding other staff (i.e. instructor therapists)
In a home program turnover can be high. Be prepared for disappointments, liars and strange people selling you their wares. Since I never hired anyone in my life, I think all this was weirder for me.
I have had people come to see me, show me some hand drawn colored graph of how the kids they worked with progressed.
Use your instincts.
The same job boards work for finding therapists. Network, speak to other parents. I also posted a lot of adverts on university job boards in the hopes of finding students/alumni.
York, Ryerson and UofT have free job boards you can post on. I am sure there are others like George Brown, who are churning out therapists like they were running a factory. Try them. I never got anyone off these, but I have heard of other parents having success in that area. Its free and worth trying. You can even call the student career office and ask if they can circulate your posting to the newly graduated students or print and post it somewhere. The Ryerson lady did this for me.
Most Senior therapists have a network of Instructor therapists they are used to working with in other homes with other clients. If you are lucky enough to fit in to their schedule that is the best option as you will be spending less money training them.
Attitude and work experience
Although this involves hiring, references, paychecks and watching for cheats, this is not a business. This is a human job, working with a very vulnerable person, with stressed out families with often limited resources. Look for the right attitude in your therapist. Look for a human being, who is interested in learning. Someone with an open mind who doesn't think they have all the answers or a formula.
Look for someone who walks in, shuts up, listens to you and is paying attention to your child,SILENTLY. Not someone who thinks they are so good, that they know exactly how to interact with an autistic person they met for the first time. Look for someone who is observing your child and you, rather than making a lot of noise.
If you know anything about autism, you will know that no one knows anything really.
Someone with
varied background (and not just autism or behavior therapy) is better. Look for someone who has actually spent time with a TYPICAL child. Maybe a past ECE teacher or someone who also worked with troubled teens or disabled adults and so on. These people come with a wider perspective and not just a narrow view of behavior.
Most of all look for someone who is interested in your child (and hence their career/job) and not just certifications, accomplishments and money. There is money in this job, but you cannot put a price on compassion, creativity, humanity and sincerity.
I often don't even bother replying to emails where they only ask me "what days and how many hours you looking for?".
Only bother with the people who call you or ask you about your CHILD. "Could you tell me a little about your son/daughter?" is usually a keeper.
This is a tough job. How many people do you know who work for a living and hate their jobs? Pretty much everyone. Find the one who loves their job.
These therapists are expensive, but trust me they are worth every penny when you see them bringing in their own toys, crafts, ideas. When you see them coming up with their own solutions to YOUR problems. When they take the time to search for community programs or things for your child to do. When they attend workshops, read books, share stories and take responsibility.
The going rate for a therapists in Toronto is $20-$25 per hour. A brand new girl can cost up to $15-18, but good luck finding one who thinks she is brand new enough to charge that. Most of them think they already know everything about autism the moment they graduate.
Its tough, keep looking.
The Program
Most regional programs want you to use the ABLLS for ABA. A more modern and developmental tool is the VB-MAP. At the end of the day, they are all just tools, and a good teacher uses many tools to teach. She finds the one that works for the child. She is not a slave to a method or technique, rather she has many methods at her disposal and is willing to try something else when one thing is clearly failing.
We use many tools. VB-MAP, Denver Model, RDI, Fluency and Precision Teaching and so on.
The program is based on individual needs. The days of mass trials and mountains of data are gone. Stay away from this method. There are more human ways to do ABA and teach autistic children. Find out what they are, and find people who know them.
Educate yourself constantly and keep an open mind. Don't get stuck in the corner of "Whatever we are doing is right". There is no known cure or treatment. There are some that have been studied scientifically and have produced some results, but your child wasn't part of that study, so keep an open mind.
Hopefully this has been helpful to someone out there.
Materials
My Senior therapist purchased her own binder, and other stuff. She brings in her own flash cards, although I have a large collection myself that we sometimes use.
I have an enormous collection of toys and educational material. The Dollar Store, Kijiji.ca and Craigstlist.ca are great for purchasing cheap or used items. It really depends on your kid and what his/her interests are. However no home program would be complete without Mr Potato Head, surely :D
Most of my therapists have their own collection and bring things in time to time. One of them makes her own toys!
Video taping therapists and sending this to the Senior Therapist for feedback has been our single most effective training tool. Use it.
Hours
Do not get fixated on hours. Most people will do what they can afford. If you have loads of money, usually more is not necessarily better. I don't believe in the 40 hours a week torture of mass trial ABA. Children (even autistic ones) learn in many ways and need time to consolidate learning. You cannot teach swimming and making a salad using mass trials using M&M's or tokens for reinforcers, but these are fun things to do and learn and can be taught using behavior management techniques that are more natural and flexible.
In the real world, the reinforcer for making a salad is the salad. Think about that for a second. Think about what you are actually teaching a child by repeatedly asking him to get you the cup, and then giving him an M&M or thomas tank engine token when he gets the cup. If it looks stupid to you, it usually is.
I will post more about Funded Programs and their jargon later.