If you are a parent who is selecting an ABA provider, you have traveled a long road of identifying and fighting for your child’s needs. Thanks to tireless efforts by advocates and parents, ABA services are more accessible than ever. Ironically, that can make choosing an ABA provider a challenge. You fought for ABA because your child needs this support in order to be their best selves. It’s too important to waste the opportunity ABA can afford with a provider who isn’t offering quality service. Some providers are certified to offer ABA, and some are not.
The Behavior Analysis Certification Board offers several certifications to practice ABA. A Board-Certified Behavior Analyst (BCBA) is the highest credential a professional can achieve to practice ABA. New York State requires that BCBAs become licensed after becoming board certified—this makes them Licensed Behavior Analysts “LBAs”. BCBA’s cannot practice in New York State without a license or a limited permit. People pursuing their BCBA are supervised by BCBAs and take rigorous coursework to ensure they provide quality care. Other providers who are approved by the BACB include Board Certified Assistant Behavior Analysts (BCaBAs) and Registered Behavior Technicians (RBTs). BCaBAs and RBTs still require supervision from a BCBA. If your provider does not have or is not pursuing one of these credentials, or is not being supervised by a BCBA, then they are not qualified to provide ABA. There are other providers who may have ABA training and receive supervision from BCBAs who are not pursuing a credential. Special Education teachers, Social Workers and School Psychologists may have ABA training. If they are supervised by a BCBA, then they may provide ABA services—the rules vary state by state. The most qualified person to provide services to your child is a Licensed BCBA.
Even if your provider is certified, how do you know if they are any good? As parents, it’s our job to ensure that our children are getting what they need. But if we aren’t experts in something complicated and technical—how will we know? It can be especially confusing that “good” ABA and “bad” ABA alike can look, to a layperson, just like normal play. Hopefully the highly trained professional taking hours of your child’s time each week is making a meaningful and impactful difference, but what if they are not, or could be doing more? How do you know if the quality of ABA therapy your child is receiving is “good”?
There are 7 Dimensions to quality ABA. If your provider is “good” they will be employing all of them in their practice. Here they are, in laymen’s terms, to help you to assess if your child is getting the quality of service you are looking for.
An ABA provider’s goal is to increase behaviors that are beneficial to your child; and decrease behaviors that get in their way. It’s all well and good if your child can be a perfect angel in the presence of their therapist. In fact, it’s great to see your child being successful with their provider! However, for ABA to be socially significant, the skills your child exhibits with their ABA provider need to generalize across settings and care providers. If your child can only exhibit skills in school, then their skills have not generalized. It means that their provider needs to work to teach in such a way that skills can transfer. That being said, skills cannot generalize without parent and caregiver buy in. So, if you want to set your child up for success, collaborate with their ABA provider to make sure you feel comfortable and confident employing the strategies they recommend.
It needs to work. One of the things that sets ABA apart is that because efficacy is one of our 7 dimensions, we take data on your child’s progress so we can be sure we are honoring it. Your ABA provider should be taking scrupulous data to ensure that they can prove if their intervention is working. If it’s not working, the data should reflect that and a change in programming should be implemented. It might take a while for a provider to find an intervention that is effective for your child. Skills are often broken down into tiny steps to ensure accuracy and acquisition. If your child has some challenging behaviors that have been effective for them in the past, it can take even longer to see the results you are looking for. There may be a period where your child is “unlearning” maladaptive behaviors—but that should also be reflected in your provider’s data. If you’re not sure if an intervention is effective, ask your provider to show you their data. The rationale behind their clinical decisions should be clear if an intervention is not showing the progress you were expecting.
This component is especially important to ABA. ABA procedures should be written out in an extremely clear manner to be sure that anyone can replicate it. Remember Dimension 1—Generality? When interventions are technological, it helps us generalize because anyone can consistently provide the same intervention for your child, which will help skills generalize across providers. All techniques, procedures and components of an intervention should be explicitly described. You can think about it like a recipe for a finnicky souffle—it needs to be clear enough that anyone can bake it without the souffle collapsing. If a procedure is not technological, it will not be replicable and is therefore not good ABA.
Applied in this context means that the intervention must be socially significant to your child. Socially significant means it has a valuable impact on a child’s life. We could use ABA principles to teach a child to flex their toes one at a time. But is that a valuable skill that will improve their lives? Not likely. It is easy to get caught up teaching children skills that a therapist has taught other children in the past. However, if they are a “good” therapist, instead of cycling through familiar programs they will create individualized goals and procedures designed for your child. Here is an example. Let’s say your child hates turning left out of your apartment building, and will throw a fit unless you turn right. When you turn right, you pass the dog park. Your child loves to watch the dogs, but sometimes you need to turn left to make it to the subway in time. In this case, a socially significant goal for your ABA provider to work on is helping your child to tolerate turning left out of your building door and not seeing the dog park. Now let’s say that this program goes swimmingly, and your provider feels great for the success they have had. Since this program was successful with your child, maybe they should implement it with all of their other clients as well! Here, unless the other clients also could not tolerate turning left out of their building, that goal would not be socially significant for other children and therefore would fail the “applied” dimension requirements.
5. Conceptually Systematic
Conceptually Systematic means that our interventions are research-based and reflect and incorporate the principles of the science of behavior analysis that have been proven to be effective by research in the field. We are really big into evidence-based treatments in ABA. Often times, ABA providers can struggle with providers from other disciplines who do not have strong research backgrounds guiding their treatments and want ABA therapists to carry over their interventions. That conflict between providers is actually a sign that you are getting “good” ABA. So, let’s say you find a new treatment without research to back it up and want your ABA provider to implement it. You will know if your provider is “good” if they politely decline. If there is not strong research backing an intervention, we ethically cannot provide that intervention.
Remember how one of the earlier dimensions was “Effective”? Analytic plays into that. In order to know that our treatment is effective, we have to analyze the data we have been taking on our intervention. Therefore, data must be collected. If the data is trending in the direction we are looking for (increasing skills, decreasing maladaptive behaviors), then we know to keep doing what we are doing. If the data has plateaued or is not moving in the right direction, your provider needs to assess why this could be and if a change is warranted. These data are usually collected in a program book or on an electronic platform. It is pretty simple to assess as a parent if your provider is being analytic—just ask them to walk you through your child’s progress in their programs.
The sciences of behavior works by making changes to a learners environment to impact their behavior. Since we need to be analytic and technological, these behaviors must be observable. If they are not observable, we cannot take data on them. There are some work arounds here. If a child is sophisticated enough to self-report on their thoughts or feelings, we can use those reports as a measure. For the most part though, behavior means “anything a dead man cannot do.” For example—can a dead man wear glasses? Yes. Therefore, wearing glass is not a behavior. But what if your goal is to get your child to wear their glasses? Removing glasses, is a behavior. So a good ABA therapist would teach your child to reduce the behavior of removing their glasses and increase the behavior of placing their glasses on their face.
Of course your provider might be doing all of these things and still just not “click” with your child. That does not mean that they are a bad therapist, but even a good therapist isn’t the right fit for every family. It’s your job to assess if a therapist who employs all 7 Dimensions of ABA in their practice is a good fit for your family. Not sure? A good therapist should explain their reasoning to you. They should communicate with you reliably and if something makes you uncomfortable, they should talk with you about it to work towards a mutually agreeable solution. Good providers should be reliable, timely and professional. And if they are all of those things, but they still don’t “click” with your family, a good provider should help you to find someone who will.
Written by Dorrie Barbanel, LMSW, BCBA, LBA