1) Comprehensive Interventions
Our primary service is the provision of Early Intensive Behavioural Intervention (EIBI) to children with some developmental disability either in the child’s home, school or day-care facility. We offer skill‐acquisition programmes that vary between 6 and 40 hours per week, and involve a 24‐week reporting cycle for parents and funding agencies.
Our comprehensive interventions are provided in a service model that has been adapted from models operating in various world-leading agencies serving children with developmental disabilities in the USA. (These models have evolved in those states where private health‐insurance companies have been mandated to cover the costs of ABA for people with an ASD.) Like those agencies, we strive to be completely transparent with the nature and cost of our services, and we consider ourselves accountable for the outcomes achieved with all our clients.
A dozen other features of our comprehensive interventions include:
a. Compliance with the Behaviour Analyst Certification Board’s (BACB’s) Practice Guidelines for the use of ABA in the treatment of Autism Spectrum Disorder (see http://bacb.com/index.php?page=100772) and their Guidelines for Responsible Conduct for Behaviour Analysts (see http://bacb.com/index.php?page=100579)
b. Comprehensive & systematic assessments of a child’s communication, social, self-care, academic, community-living, gross/fine-motor skills, school-readiness, leisure and independent-play skills. Conducted prior to most skills being taught and at regular intervals thereafter
c. Accountability for each child’s outcomes via formulation of specific and measurable performance goals that are individualized, described in an IEP, discussed with legal guardians, and reviewed in 24-week reporting cycles
d. Use of only empirically-validated interventions described in peer-reviewed scientific journals publishing research in ABA and EIBI
e. On-going measurement of behaviour change during intervention to enable data-based decision-making in both skill-acquisition and behaviour-reduction programmes
f. Highly-skilled direct-teaching staff studying ABA & seeking certifications offered by BACB
g. Education & skills training for key caregivers (e.g., parents, teachers, Educational Assistants, day-care staff)
i. A 3-tiered supervision model where a Case Manager crosses over with a Behaviour Technician and child-client after every 10 hours of teaching, and the Clinical Director crosses over with the Case Manager and child after every 50 hours of teaching
j. Consultative services available from some world-leading clinicians serving people with ASD. Advice may be sought formally (via client referral) or informally (via personal correspondence)
k. Use of written teaching and data-collection protocols offered in the Autism Curriculum Encyclopedia (ACE). The ACE is an ever-growing library of lesson plans that is maintained by the New England Centre for Children – a world-leading agency in autism research and special education. (See http://www.acenecc.org)
l. Maintenance of a limited and small client base to ensure a personalized service, maximal effectiveness with all clients, and compliance with the BACB’s Practice Guidelines
The service we provide to NEW CLIENTS receiving a comprehensive intervention involves the following stages:
- Initial 2-hour Interview with Parents/Guardians
- Presents an opportunity to discuss service models, funding options, and priorities for intervention. The Clinical Director (CD) and a Case Manager (CM) will identify the assessment protocols that will be most useful.
- Up to 10 hours of Initial Assessment
- The CD and a CM will provide multiple 2-hour sessions where teaching of simple skills is combined with tests for various skill deficits (e.g., VB-MAPP, Key Skills Assessment of the ACE), instructional assessments and preference assessments. Generally, the lower a client’s skill level, the less time is required for this phase, and a maximum of 10 hours has been set.
- Report of Assessment & IEP Proposal
- The CD and the CM will draft a report of the assessment results and propose a set of specific performance targets that they believe our staff can teach the client within 22-23 weeks given the # of hours per week being purchased. These targets will challenge our staff but also be realistic goals.
- IEP Meeting
- The IEP proposal is sent to parents/guardians prior to a 1-hour meeting at which it is discussed with the CD and CM. The parents’/guardians’ formal acceptance of the set of performance targets is sought and the contribution required of various parties toward meeting those targets is discussed.
- Staff Training Sessions
- Although our teaching staff are appropriately qualified and experienced to provide EIBI services, they might have limited experience with some of the goals and teaching protocols in this IEP, and/or some behavioural nuances of this child. Consequently, the CM will provide up to 4 hours of training for each of up to 3 Technicians in this child’s set of teaching tasks. (The # of technicians/child will depend on the # of hours/week purchased for that child.)
- Regular Teaching Sessions
- The majority of teaching sessions are usually 2 hours long & involve our Behaviour Technicians following written protocols for teaching various skills, and measuring progress toward mastery of those skills. Any behaviour-management protocols will be fully documented and approved a priori by parents/guardians.
- CM Supervision & Updating Sessions
- After every 5 regular teaching sessions, the CM observes one of the technicians teaching the child for 1 hour. The CM spends the second hour finding new target responses or stimuli for specific tasks (updating tasks), problem-solving methods used in any tasks the child is learning too slowly, and/or working with parents or other caregivers.
- CD Programme Reviews
- After every 25 regular teaching sessions, the CM & the CD teach and test the child for 1 hour. The primary purpose of this session is to review the child’s progress toward the targets specified in his/her IEP, and for the CD to supervise the CM’s problem-solving and task updating.
- Progress Review
- After 24 weeks since the Initial Interview, the CD, CM, parents/guardians and child will meet to assess whether the performance targets described in the child’s IEP have been achieved. Data reflecting direct and reliable measures of the child’s behaviour in various tasks, and live demonstrations of a sample of targeted skills, are demanded as evidence of a child having satisfied a goal. These reviews also present an opportunity for the parents/guardians (and perhaps the child) to reevaluate the need for continued services from our agency given the child’s progress and any significant changes in his/her life.
The service we provide to RETURNING CLIENTS receiving a comprehensive intervention also involves a 24-week reporting cycle and the same stages as those provided to new clients except that:
- There is no Initial Interview with Parents/Guardians
- Less time is spent assessing the child’s skills and skill deficits (maximum 4 hours)
- The IEP is a shorter document albeit with performance targets that are similar in number and detail
- Fewer initial staff training sessions are provided (maximum 2 hours per technician)
- Note: The fees charged for a comprehensive intervention delivered to returning clients are lower than those charged for new clients and reflect these service differences.