Coordinating ABA Therapy with Healthcare Teams

A CONVERSATION WITH MATTHEW NORDMAN, BCBA, REGIONAL DIRECTOR FOR THE AUTISM THERAPY GROUP

Q: WHY IS IT IMPORTANT FOR PARENTS TO KEEP THEIR BCBA INFORMED ABOUT THEIR CHILD’S OVERALL HEALTHCARE NEEDS? FOR EXAMPLE, DO BCBA’S NEED TO KNOW ABOUT THINGS LIKE ROUTINE DOCTOR VISITS?

Matthew: Parents want the best care for their child, of course. And that means doing all they can to ensure that their child is getting the highest quality care across every area of their life. This is much easier said than done.

I mean, parents of all children have to deal with healthcare situations that are challenging. Taking their child to the dentist to get their teeth cleaned or taking them to vaccination appointments can present a behavior landmine for any parent. But, for parents of children with autism, these types of situations are even more challenging.

So, often the first thing parents look for when reaching out to their BCBA for help with other healthcare appointments, is behavioral support. And, that’s great. We can absolutely support parents in that way.

Just a couple of weeks ago, I was working with a child who needed to get some vaccinations. Based on past experience, the parents were concerned about how their child would behave at the doctor’s office. Because they talked with me beforehand, I was able to provide support in the form of implementing preventative strategies into the child’s ABA therapy sessions.

Q: WHEN IT COMES TO ENSURING THAT THEIR CHILD GETS THE HIGHEST LEVEL OF CARE, ARE THERE THINGS OTHER THAN BEHAVIOR THAT PARENTS CAN RELY ON THEIR BCBA FOR ASSISTANCE?

Matthew: Absolutely. In fact, many of the kids we work with don’t really have behavioral issues in healthcare situations. But, for most parents, having the insight and opinion of their BCBA makes their job much easier.

ABA therapy is evidence based and a huge part of the process is collecting data. BCBAs create a plan for each child based on recorded data about how they behave. Over time, the BCBA records changes in the child’s behavior and makes adjustments to their therapy plan accordingly.

So, while behavioral support is a huge part of that, BCBAs can also arm parents with the data and information they need to make informed decisions about their child’s care. This is especially important when it comes to working with the child’s school and, if they are seeing one, the child’s psychiatrist.

In IEP meetings, the parent often has to advocate for their child to get the services they need. If the BCBA is involved, they can offer guidance, observations, and hard data to demonstrate why the child needs particular accommodations or support. Sometimes this means talking with the parents and arming them with the right information so that the parent can advocate for their child on their own. And sometimes this means having the BCBA attend IEP meetings. Outside of the home, the child’s school is usually the biggest influence in the child’s life. So, coordinating ABA therapy with the care they receive at school is extremely important.

It’s also really important to have the BCBA involved in psychiatrist appointments. Although the BCBA may not always be able to physically attend the appointment with the parent (but it does still happen when necessary), we can still always equip the parent with data that will have a direct influence over psychiatric treatment.

Let’s say a psychiatrist asks a parent if their child is still hitting. A BCBA is able to provide data that’s much more specific than a simple “yes” or “no”. For example, “Two months ago the child was hitting at a rate of 4 times an hour, but this month the average is only 1 1/2 times and hour.”

Another thing that comes up a lot is a child who behaves well in the psychiatrist’s office, while acting out aggressively at home. In those kinds of situations, the BCBA can provide documentation of behavior that the psychiatrist wouldn’t have access to otherwise. In general, psychiatrists appreciate that level of involvement from a child’s BCBA.

Q: ARE THERE ANY SITUATIONS IN WHICH THE BCBA MIGHT ACCOMPANY PARENTS TO HEALTHCARE APPOINTMENTS OUTSIDE THE HOME?

Matthew: In general, insurance companies won’t cover the cost of having a BCBA accompany the child in community settings. This means that if a parent wants their BCBA to come with them as they take their child to an IEP meeting or to a doctor’s office visit, they have to pay out of pocket. Most parents simply can’t afford that.

At ATG, when there is a situation in which the best thing for the child is for their BCBA to go with them to a school or healthcare appointment, we do it even if the insurance won’t cover it and the family can’t afford it. We are serious about providing the level of support that our clients need and will do so regardless of insurance red tape and financial impediments.

But, in most situations, it’s not necessary for the BCBA to go with the child to outside appointments. There is a lot that a BCBA can do before the appointment to prepare the child and the parent. For example, ABA therapy might include a lot of social skills training aimed directly at helping the child know how to behave in situations that are unexpected or that come with a lot of sensory input.

The BCBA will often also work with the parents, coaching them and offering advice for how to handle their child in a particular setting or situation. We can provide more support than most parents think in helping them understand what treatment options might be in the best interest of their child.

Q: DO PARENTS USUALLY UNDERSTAND THE LEVEL OF SUPPORT THEY CAN RECEIVE FROM THEIR BCBA BEFORE THEIR CHILD GETS STARTED WITH ABA THERAPY?

Matthew: In almost all cases, when parents first start working with a BCBA they vastly underestimate the power of that relationship. They are often also surprised to learn how many hours of ABA is recommended and how involved their BCBA can be in supporting the child’s care outside of the home.

At ATG, these are things that we communicate during the assessment process and parents are usually very pleasantly surprised. We also do our best to schedule a school observation along with the initial assessments and gather information about any other treatment the child is receiving. We ask questions to understand how the child behaves all these situations and what the parent’s challenges are in managing their child’s care.

What most parents don’t realize at the beginning of ABA therapy is how central the relationship with the BCBA will become to all aspects of the child’s development. I mean, it doesn’t do the family a lot of good if ABA therapy only applies to the child’s behavior inside the home. All the skills learned in ABA therapy must be generalized to the outside world.

One thing that’s important for parents to understand is that ABA therapy is evidenced based. So, if the parent wants their BCBA to implement a strategy for which there is no clear evidence for how it supports ABA therapy, the therapist is not likely to implement it into their therapy sessions. For example, swim therapy is popular with many parents of children with autism but there isn’t evidence that swim therapy directly supports ABA therapy. So, even if a parent wanted their BCBA to implement swim therapy into ABA therapy, the BCBA would not be able to do so.

The most important thing for parents to know is how important it is to provide their child’s BCBA with information about every kind of care the child is receiving even if they think it doesn’t apply to ABA therapy. We can often offer advice and support that will benefit the child’s overall care to a significant degree.

We are here to support families and their children in every way we can.

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