o Assessment and Authorization of Services Process: Each individual will be screened and assessed for eligibility of services to ensure that ABA therapy is the most appropriate and effective treatment option available (please see medical necessity and eligibility criteria definitions for insurance providers below). Once determined appropriate, a service authorization request will be submitted to the client’s insurance agency outlining treatment duration and intensity necessary for effectiveness of services (e.g., 20 hours per week for 3 months). Once services are authorized through the insurance provider, comprehensive clinical assessments will be conducted to determine client specific needs and identify strengths and weaknesses across domains and potential barriers to treatment. Clinical assessments utilize information obtained across a variety of informants and methods including: reviews of files containing previously administered developmental assessments, comorbidities, intellectual and achievement tests, and medical information, interviews and rating scales related to adaptive behavior and functional skills completed by caregivers, teachers, clients, and other appropriate individuals, and direct assessments and observations conducted by the BCBA including but not limited to VB-MAPP, ABBLS, EFL, ISCAA, and FBAs.
o Individualized Service Plan (ISP): The BCBA, working as a team with the family, client, and other relevant providers and professionals, will then compile identified areas of need gathered through assessments and create the client’s Individualized Service Plan (ISP) and Behavior Support Plan (BSP), as appropriate. Each client’s ISP is specifically tailored to address determined deficits and each goal/objective is designed to be specific, measurable, achievable, relevant, and time-bound. The ISP will be reviewed as a team with the family/caregiver and client and agreed upon prior to implementation. Additionally, the ISP will incorporate domains related to family/caregiver expectations, service collaboration and consultation, and discharge planning, and will be shared with all relevant service providers including the client’s primary care physician. Client ISP goals and objectives will be analyzed and evaluated continuously by licensed clinicians to ensure effectiveness of interventions and appropriateness of services.
For further information related to ISP creation, please click here.
Family and Caregiver training is a supportive component of treatment, but is not done in isolation or as a replacement to direct therapy! Training of family members and caregivers involves a systematic and individualized curriculum on the basics of ABA and how to utilize such with the client in the natural environment. Client ISPs will contain objective and measurable goals for families and caregivers that emphasize skill development and support to ensure competency and behavioral change across time. Primary areas addressed include but are not limited to: generalization of skills across settings, adaptive skills training such as functional communication or hygiene routines, contingency management, appropriate play skills, use of reinforcement and punishment based procedures, and treatment of aggressive, self-injurious, or other unhealthy or socially inappropriate behaviors.
Coordination and collaboration with other professionals helps to ensure client progress during intervention and aids in transition periods and discharge from services. Client goals and objectives are more likely to be achieved when there is consistency of implementation across providers, professionals, and others involved in the client’s life. According to the CMHRSS Behavioral Therapy regulations ‘behavior therapy must be coordinated with other medical services to effectively increase adaptive functioning.’ (p. 9). All collaborations will be conducted in accordance with regulations outlined by governing bodies. If treatment protocols are proposed or are being used by other professionals that conflict with or dilute the effectiveness of ABA evidence-based treatment interventions, these differences will be addressed and resolved to ensure effectiveness of ABA services moving forward. If resolution is unachievable, the BCBA will follow the ethical compliance code and recommend the most effective scientifically supported treatment available for the client.
(insert link to ethical code and BACB practice guidelines p. 38 and 39).
ABA in-home therapy is designed to be a short-term intensive service. Desired outcomes for discharge from services will be discussed at the onset of services and throughout treatment. Families, caregivers, and other professionals will be involved in the ongoing evaluation of treatment and ultimate transition out from services. Service discharge will generally involve a gradual step down process in which hours of treatment are reduced across time and generalization and maintenance of skills are observed. Discharge occurs when the client has achieved treatment goals and objectives, no longer meets eligibility criteria for services, does not demonstrate progress or shows no meaningful or measurable improvements, family requests discontinuation of services, treatment is making behaviors persistently worse, the client is medically unstable to receive services, family and provider are unable to agree on treatment planning and implementation, or family refuses or is unable to participate meaningfully in the treatment plan. Families will be notified in writing five business days prior to service termination or suspension when the discharge is not due to health, safety, or welfare of the provider (see p. 18 of CMHRSS).