Why fancy clinics do not equate to high quality treatment
When I left Austin in 2017, the ABA space is very different than it is now in 2023: in home was the primary service location, clinics were few and far between, and the level of parent involvement was quite high. When I returned in 2022, what I found was a push to have a clinic on every corner for ease of access for families which has been an amazing benefit to our community. Unfortunately this shift has caused some falsehoods to be shared amongst the community as parents are deciding what is best for their child.
Falsehood #1: The best space for a child to learn is a clinic with amenities.
Don't get me wrong, I love to see these beautiful spaces catered to children with sensory needs, open play yards for running, and teams of staff working with children in groups. Unfortunately, none of this speaks to a child's treatment team's training or experience. In some of the most beautiful clinics you can often find staff that is new to ABA as a field or has had very limited training time hands on. As a parent, ask the questions about the staff more than just what amenities you will have access to in the clinic.
Falsehood #2: Clinic based services means faster learning for children.
This is a big one I have heard many times. While we can see rate of acquisition at times pick up in the clinic setting, this does not take one very important component of treatment into consideration: generalization. In a clinic we simply cannot replicate real life; we have the benefit of controlling for 99% of variables we encounter from access to items the child wants, limiting attention due to being in a space it is feasible to do so, and no other family members in the space maybe working against the behavior plan. But what happens when you go home. Point blank: A clinic is not real life. When you can push services into the home setting, in tandem with the social benefit of a clinic, you can truly see some amazing results. Definitely ask how you can push into the session to support your child's generalization of skills.
Falsehood #3: Clinics result in less turnover on a child's therapy team.
This is a tough one. ABA continues to face high turnover rates. As someone who has worked in home and clinic based, I did not truly see a difference in turnover rates. What can impact turnover rates are things like encouraging growth in staff, investing in those who are wanting to stay in the field, providing training that is ongoing and not just a one time thing. Ask your potential provider about what mentorship they offer their staff; don't simply assume they are doing these trainings at a baseline.
Falsehood #4: ABA clinic behavior technicians are qualified to include speech and occupational therapy goals.
I would argue this is the most egregious falsehood due to the ethical code we are bound to as well as our commitment to working on collaborative, interdisciplinary teams. If you were told that your ABA technician is going to "push in" speech and OT goals, run as fast as you can from this provider. Ask them how they plan to do this and how you can reduce hours so that your child can get these very necessary services from other providers who are specialists in these areas! A behavior technician typically has a high school diploma, with some working on their college or graduate degrees. Due to the variability in their education, there are no guarantees of what they are qualified to work on. The most ethical way this can be done is by having your BCBA collaborate with OT and Speech, gain training, and this be disseminated from BCBA to behavior technician with regularly scheduled check ins with the OT or speech language pathologist.
ABA will continue to grow and change as a field; this is the only way things go! As consumers of the services it is critical to be well-informed and know what questions to ask. While we are strictly in-home or community based services, we know directly what can impact client progress. Feel free to message with questions any time on green or red flags when considering service providers, especially the ones with all the bells and whistles.