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ABA Therapy

What Is Chaining & Why Is It Important?

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Many children with autism struggle with behavioral issues, which is often why parents seek out ABA therapy. Applied Behavior Analysis (ABA) is a popular therapy for treating autism and other developmental disorders. Children with autism think differently and need different kinds of support, and ABA therapy allows the child to learn skills in a more supportive environment. 

What is Chaining in ABA Therapy?

One teaching method that’s typically incorporated in ABA is something known as a behavior chain or chaining. This method, which breaks the steps of directions into instructions that link to each other (hence, the term “chaining”), allows kids to complete an entire task that they otherwise would have struggled to complete. The string of behaviors links together to create a terminal behavior.

ABA Therapist Teaching Young Boy Skills Using Chaining Techniques

Chaining is useful because it helps children become proficient in completing complex directions that involve multiple steps. Its 3 main approaches (forward chaining, backward chaining, and total task chaining) are all designed to help a child learn complex, multi-step skills, like learning to wash their hands independently.

How is Chaining Done?

Chaining works by breaking a task down into small steps and teaching each step by itself within the sequence.

Let’s use the example of a child learning to wash their hands independently. In chaining, the child might start with learning how to turn the faucet on. Once the child has learned this initial skill, the next step might be for the child to learn how to put their hands under the water. After that, the child might learn how to scrub their hands.

The child continues to learn all the steps of washing their hands until they can wash their hands completely on their own. This process is done with the supervision and guidance of an ABA therapist, who then works with the parents to ensure progress is made at home. ABA therapy is, after all, only one part of the process! It’s important for practice and progress to be made at home, so the child can get used to performing these tasks in various settings. 

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When Should Chaining Be Used?

Chaining is usually recommended when a child consistently misses or skips steps, completes steps incorrectly, or is only able to perform some of the steps.

For example, when learning how to wash their hands, the child simply touches the faucet handle instead of turning it. That would be an ideal situation to incorporate chaining. The task of washing hands would be broken down into smaller steps, including the step to turn the faucet handle, and each step would be taught by itself until the child can independently wash their hands all on their own.

Parent Showing Child How To Wash Hands With Soap Using Chaining Techniques

Another example would be the child independently turning the faucet on, rinsing their hands, and turning the faucet on, but consistently failing to get soap. Chaining would be used similarly in this example. The task would be broken down into smaller, more manageable steps until the child can perform the entire task, including getting soap, in its entirety all by himself or herself. 

How do the 3 Types of Chaining Procedures Work?

Chaining works by building off of the skills that the child already knows. Based on what steps the child has already mastered or feels comfortable with, there are different chaining methods that can be used. The following methods can be used independently, or sometimes used together to help give the child support. 

Forward chaining

This type of behavioral chain begins with the first step. The child has to complete the first step on their own, and they’re prompted for all the remaining steps. Using the washing hands’ example, the child would independently turn on the faucet, and all the steps that follow would be prompted. Forward chaining is the recommended method if the child is able to complete one or more steps at the beginning of the behavior chain.

Backward chaining 

Backward chaining is much like forward chaining, but instead of having the child independently complete the first step, you have them independently complete the last step. For example, when teaching the child how to wash their hands, you prompt the child to perform every single step except the last one (e.g., drying their hands with a paper towel), which they complete on their own.

Total task chaining 

This chain involves teaching the complete behavior chain one step after the other. Unlike forward and backward chaining, total task chaining doesn’t start or end with the child completing a step independently. Instead, the adult walks the child through all the steps, prompting whenever necessary. For some children with autism, total task chaining is too difficult and complex. Therefore, forward chaining and backward chaining are more commonly used for children who fall on the autism spectrum.

What’s the Difference Between Chaining and Task Analysis?

Chaining and task analysis often go hand in hand with each other. In fact, chaining is based on task analysis, which recognizes individual steps as requirements for the mastery of a task.

Young Boy Answering ABA Therapist's Questions For Chaining Exercise

As you well know, chaining breaks a task down into a series of small steps and teaches each individual step within the sequence. Similarly, when conducting a task analysis, the ABA therapist first needs to determine the task that needs to be taught. Afterward, they write down the steps of the task, making adjustments as needed. 

The therapist will then present the task to the student and watch their performance with each step of the task. Based on what they do and how they perform the task you gave them, the therapist is able to observe and gather insights. They can then decide which chaining techniques to use, and they start incorporating the chaining techniques. 

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Conclusion

As you can see, chaining can be a very effective way to teach children certain tasks, especially everyday repetitive tasks like washing hands and using the toilet. Because the method breaks down tasks into smaller, more doable steps, it’s helpful when teaching kids how to perform longer, more complex tasks.

But no two children are the same. Every child has their own strengths and weaknesses, and that’s why there are 3 types of chaining: forward chaining, backward chaining, and total task chaining.

Though this is most often used by therapists as a part of ABA therapy, it can also be used at home by parents. If you’re curious to get your child involved in ABA therapy, or you just want to know more about chaining, reach out to the therapists at Circle Care. We’re a New Jersey-based ABA therapy agency, and we help families of children with autism all across New Jersey. Reach out today to learn more about using chaining with your child!

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What is ABA Therapy and How Does it Work?

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ABA (Applied Behavior Analysis) is an evidence-based therapy that has been widely accepted as the primary form of therapy for children and adolescents with autism.

A Woman Helping A Little Girl Work On A Foam Puzzle

What is ABA used for at Circle Care?

ABA therapy is used to improve behaviors like social skills, reading, academics, and communication as well as learned skills like grooming, hygiene, fine motor dexterity, job proficiency, and even simple things like a child keeping his room clean.

The Goal:

To establish or increase socially acceptable behaviors and diminish or extinguish socially unacceptable behaviors that would cause the child to feel excluded from social settings and peers. 

How is this accomplished?

At Circle Care Services, one of our Board Certified Behavior Analysts, (BCBA) will:

  • Analyze atypical behaviors
  • Identify the triggers that bring on each one.
  • Outline a plan to alter the child’s experience.
  • Break down long term goals into bite-sized achievable steps which are then
    • Practiced
    • Reinforced
    • Mastered

For example:

Daniel’s mom says “he tantrums all the time” but upon analysis, his BCBA identifies that his tantrums occur when attention is being diverted from him to others. Now, the BCBA will outline a step-by-step plan to reach the desired long-term goal; developing a more appropriate way of getting attention. The plan is then implemented and skills are practiced, reinforced, and mastered.

I want to help my child.

Beginning ABA Therapy Services for your child

First, a Circle Care BCBA will set up an interview with you and your child to gather all the information needed for successful therapy sessions. 

Your child’s likes and dislikes are important for creating positive reinforcement, both through fun activities and prizes and treats.

A Little Boy Playing With Blocks While A Woman Holding A Clipboard Watches

The BCBA will then perform a Functional Behaviour Assessment (FBA). 

What is this?

  • Observing and collecting data about your child’s behavior
  • Identifying which behaviors to target in therapy
  • Create a treatment plan for the Registered behavior tech (RBT) who will actually be working with your child.
I want to start with an evaluation

What does it look like when my child is in therapy?

Once you’ve decided to pursue ABA therapy for your child, the process can seem a bit scary. You’re not sure what to expect when starting ABA, and you don’t know what a session will entail. Though this can look a little different for every child, your ABA agency will be sure to go over the treatment plan with you.

Once the treatment plan is in place, it’s time for your child to meet one of our Registered Behavior Technicians (RBTs) who will provide the individualized ABA session at each visit. 

Our RBTs work under the close supervision of our board-certified behavior analysts (BCBA) with an occasional visit to update the treatment plan when your child masters skills and new programs are added.

Our ABA therapists work towards establishing a good working and playful relationship with your child. ABA sessions should be something that your child looks forward to!

If your child is dreading the arrival of the therapist, it could be concerning, but don’t jump to replace the therapist immediately. Sometimes it takes some time for your child and the therapist to “pair” for the first couple of sessions. In ABA therapy, we call this process “pairing”.

A Woman Smiling And Holding Up A Piece Of Paper With A Smiley Face And Another One With A Frowny Face While A Little Girl Points To The Paper With The Smiley Face

Our therapists are good with children: energetic, playful, and creative enough to integrate the treatment plan into playful activities so that the work doesn’t feel like work – it feels like fun! 

This is included in what we call natural environment training: taking a skill that has been worked on in therapy and applying it to a more natural setting, like playtime. This helps your child to generalize a skill in more than one area, rather than learning it only while sitting at a desk with the therapist.

Learning Pivotal Skills In ABA Therapy

In the beginning stages of therapy, some of the most essential skills to establish are the pivotal skills that all other skills will hinge from. Pivotal skills include:

  • Motivation
  • Self-initiation
  • Self-management
  • Responding to multiple cues

Without pivotal skills, it is hard for a child with autism to focus. 

These skills are foundational, and when mastered through praise and reinforcement, your child will be likely to repeat and use them in other areas.

Children with autism who master pivotal skills are able to sit and listen and have the motivation and the self-management to work to improve communication and language skills.

This helps them grow academically and socially.

I want this for my child!

What a Circle Care ABA Session Looks Like & The Treatment Plan

How long is a session?

  • This will vary depending on the age of your child and the number of hours that are required to reach the decided-upon goals.
  • Every child is approved for a specific number of hours per week up to forty hours per week, depending on need.
  • On average, most sessions in your home will run for no less than two hours. 

Where do sessions take place?

Our RBT will choose a space to start the session based on your wishes, the child’s interest, and their own assessment of where they can be most successful to accomplish the goals of the day. 

With playful interaction, your child will warm up to the idea of spending time together at the table, in the playroom, or anywhere where your child will be able to achieve the desired outcome.

Our RBT has the tasks of keeping your child focused while running the program, entering real-time data as it occurs, and delivering reinforcement when your child responds appropriately. 

The behavior tech will also keep your child’s motivation high to keep working. The best way to do this is to be prepared by having materials ready for the session and having the work environment as distraction-free as possible. 

It is the job of our RBT to team up with the caregivers to accommodate therapy in a manner that works well for your whole family. Some of the challenges that may need to be addressed are:

  • Find a distraction-free setting where your child can be attentive.
  • Finding a place for siblings to hang out while the session is going on.
  • Figuring out if it is best for the parent or caregiver to be present or not while the RBT is working with the child. 

At Circle Care, maintaining a respectful and professional openness to accommodate each other is a very important priority.

A meaningful conversation between you and our therapist will help result in an arrangement that will be practical for your family members and productive for your child with autism. 

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Discrete Trial Training and Natural Environment Training

If a child with autism has communication skills deficits, Discrete Trial Training is commonly used to start teaching them the skills that they need.

It is an extremely repetitive type of teaching and it can be difficult to keep the child motivated without a heavy schedule of reinforcement. For example, the RBT might present a picture of a cat and say “cat” and then ask the child, “What is it?” 

When the child answers “cat”, the RBT reinforces the child with praise and smiles and whatever other reinforcers have been identified.

A Woman Sitting And Blowing Bubbles While A Little Girl Sits Beside Her Watching And Smiling

How do our RBTs know what keeps your child motivated? Is it a certain toy? A minute on the tablet? Coloring? Tickles? Bubbles? A Skittle? If it is unclear what motivates your child, the RBT or the BCBA can conduct an informal preference assessment and get an idea that way.

It can be tricky because what works one week may not work the following week. Our therapists realize the importance of remaining flexible and being ready to conduct some quick informal preference assessments when a child with autism switches things up.

As your child builds upon those pivotal skills and reaches some of the goals in communication and social skills, our RBTs will help the child to transition those skills to more natural situations. For example, a child may be able to say “ball” each time a picture card is held shown, but will the child say “ball” if the RBT holds one up and waits for the child to request it? That is the goal! To generalize the skill to give it meaning!

No Two Sessions Are Alike

Every session will be different. There will be days that are filled with successes and other days that are filled with frustration. The RBT will take careful data and detailed notes that the BCBA can look over and discuss with the RBT to make improvements, add or delete programs or change direction on something that was previously discussed. 

Because each child’s therapy is so unique, parents must receive one on one training to carry over what is being taught and practiced with the RBT. The BCBA is responsible for parent training and will steadily educate parents about what they can do to contribute to their child’s overall success. ABA is most successful when parents are willing participants in the therapy that their child is receiving. The more that parents know about how ABA works, the more successful the child with autism will be because there will be consistency in the way that everyone is communicating with each other and with the child.

Sessions can take place at home, in our clinic, and even at school. 

The most important aspects of therapy are a skilled RBT who is:

  • Keeping your child-focused
  • Taking accurate data 
  • Following the treatment plan as written by the supervising BCBA.

Our therapists are flexible, provide frequent breaks and get to know your child well enough to avoid anything that triggers negative behaviors or escalations. 

At Circle Care, we aim to make ABA a positive and fun experience for your child with ASD; one that they look forward to on those days during the week that are dedicated to therapy. The more positive reinforcement that is tied to the experience the greater success that there will be overall with the treatment plan.

I want my child to start building skills
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What Role Do Parents Play In ABA Therapy?

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One of the most significant factors that determine a child’s success with ABA therapy is how invested the parents of the child are in the process.

At Circle Care Services, we have noticed that a child with parents and caregivers who ask questions, take notes and carry out the procedures that the child is learning during ABA sessions, is at a wonderful advantage and has higher hopes for long-lasting results. On the other hand, a child whose family is outwardly oppositional toward ABA practices and questions the methods rather than learning them is unwittingly putting their child at a painful disadvantage.

The Biggest Challenge in ABA Therapy

Ask any Registered Behavior Technician (RBT) that has worked in the field for a good amount of time what the biggest challenge regarding ABA Therapy is, and it won’t take long before one of them answers “getting parents on board with ABA”.

My Child's ABA Therapy

Why is this? Why would a parent go through the task of getting their child (or children) diagnosed, researching ABA agencies, applying and processing with an ABA agency, and committing to 20-40 hours a week of at-home therapy, only to become oppositional to the specific remedy that they sought after so ferociously?

Well, for one: ABA is a lot of work. It works for the therapist, for the child, and for anyone and everyone that is involved with the child. There is a specific method to ABA that needs to be learned. It isn’t extremely complicated, but it does require to follow through for it to be successful. This includes mom, dad, sister, brother, grandma, grandpa, auntie, uncle and you get the picture. The moment one person runs against the program, the child who is receiving therapy will instantly catch on to that and use it to their advantage. No one ever said that children with autism are not intelligent- they can ingeniously manipulate situations to their own benefit like any other child, which is why everyone who is in contact with the child needs to be consistent.

ABA also runs counterintuitive to what we do as parents much of the time. For example, in ABA therapy when a child is using inappropriate behavior to gain attention from an adult, we would find a way to provide frequent attention at regular intervals to keep the child’s behavior appropriate. As long as the behavior remains appropriate, we would shower the child with praise and keep giving attention to the child, slowly lengthening the time between each praise so that over time, as the child is able to maintain appropriate behavior on their own, we would fade the continuous attention out.

As parents, if our child is acting inappropriately, we are not likely to feel like showering them with frequent attention and praise every 30 seconds for the smallest positive behavior. Parents are usually agitated by their own child’s behavior and they find it difficult to get into the ABA mindset of turning the inappropriate behavior around. This is how ABA can feel counterintuitive to parenting. With enough modeling by therapists and enough turnaround in their child’s inappropriate behaviors, many parents will begin to see how these methods can be successful.

I want to start with an evaluation

Why Parents Are Important in ABA Therapy

Every family is different. When an RBT visits a home, some parents will sit in on sessions and watch everything that goes on during the sessions so that they know what to do when the therapist leaves. Other parents completely disappear and take a break from the child when the therapist shows up because it is the only time that they get to themselves apart from the child. Both are valid options! Outside of ABA therapy, some parents are on duty 24 hours a day without a break. For the parents of children with severe symptoms, this can mean little to no rest, especially if the child does not sleep well.

Depending on the circumstances, there should be some opportunity to teach parents or caregivers basic principles of ABA so that they can carry on with what the children are learning during sessions after the therapist leaves. With some agencies, this is done in the form of mandatory parent training by BCBAs (Board Certified Behavior Analysts). For other agencies, it might be part of the job description for RBTs to invite the parent to sit in, model, and describe one or two of the programs they are teaching while they are running a session with the child.

Parents Are Important in ABA Therapy

The main focus during the session will be on the child of course, but parents should always be welcome to join in and participate, learning how to deliver instructions and follow through with their child.

When there is little to no interest in how ABA therapy works from parents, caregivers, and teachers, it becomes obvious rather quickly. You might have a situation where mom is following everything note for note and dad doesn’t want to follow the program. The child will eventually notice the difference between mom and dad, responding well to one parent and defying the other. This lack of consistency eventually leads to tension between the parents and questions as to whether ABA is working or not.

The same lack of consistency can happen in a classroom. If a teacher has been given the tools to work with a child and knows what to do to avoid triggering tantrums, for example, but does not follow through because of a lack of time or energy, then the child will not progress in the classroom.

Parent training is not only important, but it is crucial when it comes to ABA therapy because it ensures the child with autism is making meaningful progress. Children with parents who are not trained in basic ABA principles and who are not receiving regular parent training by their child’s ABA agency are less likely to be successful in therapy.

Repetition and consistency are at the foundation of learning for children with autism. They learn best with predictable routines. When all of the adults that are part of their learning work in cooperation with one another, they are much more likely to feel comfortable and remember what they have learned.

I want this for my child!

The Parent’s Role in ABA Therapy

As a parent, it isn’t enough to find an ABA agency, secure a therapist and assume that everything is going to be okay from thereon. Finding ABA services is just one step toward helping a child with autism make progress toward becoming independent and successful.

Parents Role in ABA Therapy

Parents need to be advocates and make sure that their children are getting what they need at school. They might need speech and occupational therapy. There may be a need for family therapy if siblings are not responding well to a sibling with special needs. Marriage counseling might be in order if parenting styles aren’t matching up.

ABA therapy can change the way that everyone in the family interacts – in a good way. One of the basic principles of ABA is that it works by using positive reinforcement. Imagine how that could change the dynamics in a family for the better!

Parent training in ABA is absolutely essential. Without it, a child might take one step forward and two steps back. But if parents and caregivers learn and understand the principles of ABA and apply them with consistency, then these children will have much greater success in all areas including academics, the workplace, community settings, and peer relationships.

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Road to Resources: The Arc & Circle Care Services

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What’s your go to resource? 

For so many families in New Jersey living with intellectual and developmental disabilities, including Autism Spectrum Disorders, the Arc of New Jersey is the go-to source of tools, information, guidance, and support. Circle Care Services had the pleasure of kickstarting their brand new podcast series: Road to Resources. The new podcast highlights supports and services for people with intellectual and developmental disabilities, beginning with ABA therapy from Circle Care Services. 

Hosted on The Arc New Jersey Family Institute’s podcast, Circle Care’s Director of Marketing, Chana Gross, answers 14 ABA related questions in 17 information-filled minutes. Listen here or continue reading to review the podcast in written form.

Lisa Ford & Chana Gross Discuss ABA Therapy

Lisa Ford:  0:00  

Hi, y’all. My name is Lisa Ford, and I’m the director of The Arc New Jersey Family Institute. I want to welcome you to our podcast with Circle Care Services. Circle Care Services provides a cohesive team of highly experienced and devoted professionals and partners who work closely with your child’s school. Their BCBAs, ABA, occupational, and speech therapists form a supportive and completely integrated service force infusing warmth, care, and focus into every session with every child. 

“ABA” Drawn With Paint Below A Rainbow

Today, we’ll be talking with Chana Gross. Chana is the Director of Marketing at Circle Care Services. Welcome, Chana. And thanks for being with us today.

Chana Gross:  0:40  

Hi, Lisa! Thank you so much. Thanks for having me. It’s a pleasure. 

Lisa Ford:  0:44  

Sure. We have a lot of questions, so I’m just going to jump right in. The first question for today is:

What is the difference between a BCBA and an ABA therapist?

Chana Gross:  0:56  

Okay, so that’s a great question. I think there’s a lot of confusion around that when parents are first starting their children with ABA therapy. A BCBA is a board-certified behavior analyst. They are the most experienced specialists with the highest level of credentialing the most schooling in the field of ABA. And so, they’re going to be the first person that comes in to observe behaviors in a child during the assessment phase, which is the first phase as the child gets started on ABA. 

They are trained extensively to collect data to analyze the behaviors that they see in the child. They create the plan of treatment and the goals for changing behaviors, for increasing communication, whatever it is that might be the goals for this specific child. They are also responsible for parent education, which is part and parcel of the ABA therapy plan. And that’s just explaining to the parents what it is that they’re doing. They’re available for parents who have questions. 

The ABA therapist works very closely with the BCBA, but their experience is not as extensive. They’re the ones who actually come in and work directly with the children in the session. So they’re taking plans that are outlined by the BCBA and implementing those plans, those goals into a structured session with a child and working with the kid, getting down on the floor. As they do that, they’ll document data, information, observations, and then they’ll go back and convey that to the BCBA. They collaborate. They work together. So, it’s a very close collaboration, and both are extremely important members of the team, but their roles are very different. Is that clear?

Lisa Ford:  3:10  

Okay. Great! Yes, very. Thank you. Okay.

I would like to speak with a professional ABA Therapist!

How many BCBAs and therapists does your agency have on staff?

Chana Gross:  3:19  

We now have close to 100 staff members on our team. 

Lisa Ford:  3:27  

Oh, wow. Wow, that’s great.

Chana Gross:  3:30  

Yeah, we have over 65 ABA therapists. And then, there’s always going to be more ABA therapists than BCBAs because they do the clinical hours, so they don’t spend much more time with the children.

Lisa Ford:  3:47  

Do you work throughout New Jersey?

Chana Gross:  3:53  

Yeah. We provide services in homes, and we can serve anywhere in New Jersey. A lot of our families come to us from Middlesex County because that is where our clinic is. We have a Center for Autism in Highland Park, where children can sometimes go into the clinic. We can service in the clinic, in the school, or in the home. 

Young Boy At Kitchen Table Doing ABA Therapy Exercises

Lisa Ford:  4:18  

Okay, that’s great. 

Chana Gross:  4:19  

Yeah, anywhere in New Jersey. 

Lisa Ford:  4:20  

Yeah, that’s great. Okay.

How will your agency’s specific ABA therapy services help a child be successful in school?

Chana Gross:  4:33  

Okay, good question. So, ABA therapy targets behaviors and deficits that are holding a child back from functioning wherever the child may find themselves, right. If the child is in school, then the goals are going to be set up around functions that will help him within the school environment. So, that might be transitioning from subject to subject, staying focused on whatever it is that the teacher is teaching, and the therapist will come into the school and kind of be that one to one aid with the child to help them get the most out of their day in school.

Lisa Ford:  5:17  

Great.

How long has your agency been practicing ABA therapy? What kind of results have you seen?

Chana Gross:  5:25  

Mother And Father Playing & Laughing With Two Kids

Okay. So, Circle Care Services was founded by the owners and founders of The Therapy Place. The Therapy Place is a speech and OT provider in New Jersey. They’ve been for the last ten years providing services for children across all communities, including the autism community. So, they’ve worked a lot in The Therapy Place with children with autism. And about a year ago, they realized the need, and especially after COVID, where children were home and not in school, and there were just so many behaviors coming out. They started a whole new division called Circle Care Services, focusing specifically on ABA therapy, specifically on providing services for children with autism. In the past year since we’ve started, we’ve onboarded over 75 clients. 

Lisa Ford:  6:27  

Wow. 

Chana Gross:  6:28  

Yeah. I guess you can say the need is great, but it’s been very gratifying to see that we can provide quality services for these children. 

Lisa Ford:  6:38  

Yeah, that’s wonderful.

What kind of training do your therapists receive?

Chana Gross:  6:44  

Before a therapist starts, they’re always going to get one on one training. We have our lead RBT. RBT is a registered behavior technician, who is a very experienced ABA therapist. So, they get that one-on-one training for onboarding. And then, once they get started, there’s ongoing training for every ABA therapist with a supervising BCBA. All our BCBAs are supervised as well by our clinical director. So there’s really a very strong, close supervision mentoring structure in place to make sure that everybody has the support they need to be able to provide the quality service that we would like to give.

Lisa Ford:  7:28  

That’s great. Okay.

What does a typical ABA therapy session with your agency look like? Are there props or tools used during therapy?

Chana Gross:  7:39  

Every child is different. And of course, it’s going to depend on their age, and it’s going to depend on what motivates them. A really big piece in ABA is identifying what motivates your child, what excites the child, what will get him to do whatever it is that you might want to do, and that’s going to be the medium through which the therapy is given. 

So, lots of our kids are pretty young. For them, everything happens through play. ABA could be taught using Play-Doh, sand trays, crayons, markers, music. It can be done on the playground. Sometimes we’re just targeting very, very functional behaviors. So, you might see a session in a bedroom, where you’re working on. Picking up laundry or whatever it might be, right? 

Potty Training is something that lots and lots of parents would like to address because that can be very difficult as well. So, you know, it really depends on what the goals are. And anything that motivates the child will be brought in. It’s a very, very individualized, customized sort of therapy.
Lisa Ford:  8:53 

Today, do your therapists work with case managers at the schools to talk about some of the goals that they have within their IEP?

Chana Gross:  9:12  

When they go into the schools, there’s that very, very close collaboration with the school teachers, and then they’re available for consultation with case management for sure. We have a lot of our therapists getting on those team meetings just to advocate for the child or to support the parent in advocating for the child. Yeah. So, there’s definitely that component. Yes.

Lisa Ford:  9:36  

Great. So..

How many therapists will be working with the child and their family? I know you talked about the team of the BCBA and the ABA therapist.

Chana Gross:  9:46  

Typically every family is assigned one BCBA and one ABA therapist, it could happen that a child who requires many hours of therapy will be assigned two ABA therapists, but that’s not a typical scenario.

Lisa Ford:  10:02  

Okay, great.

How often will families be able to meet with the BCBA assigned to manage their child’s program?

Chana Gross:  10:11  

BCBA is going to be available once a week for parents. 

Lisa Ford:  10:16  

Wow, that’s great. 

Chana Gross:  10:18  

Yes. Yeah. Insurance requires that collaboration. But I believe insurance only requires it once a month. We do make our BCBs available. They schedule sessions with parents once a week, depending on how many hours the child gets. I think that’s what will determine how long each session is. So, it is kind of like a percentage of how much therapy the child is getting, but it’s a very important piece because the therapist only sees a snippet. They’re only there for a specific amount of time, and the child needs that consistency to really acquire the skills and retain them.

Lisa Ford:  11:00  

Right. Right. Right. Okay.

How does your agency set measures and reevaluate the goals of your agency’s therapy approaches?

Chana Gross:  11:14  

Okay, so we have a quality assurance team, as well as a clinical director who stays on top of all that. Parents are really the specialist on their own children. So, parents’ input is always welcomed and always considered. It’s really like a three-part team. The BCBA, the ABA therapist, and the parents work together to constantly assess and reassess goals. We set goals. We reach them. We reassess. So, there’s that process that’s ongoing. 

Lisa Ford:  11:50  

What happens if a parent is looking for an additional goal to be included?

Chana Gross:  11:56  

So yeah, parents actually have access to our portal, where we have all the goals mapped out and all the programs set up so they can see what’s going on. And they can always reach out to the BCBA. Anything that’s concerning them, anything that’s on their mind, anything they’d like to switch or add. There’s that constant communication. That’s really important.

Lisa Ford:  12:23  

Yeah. And, you know, you talked a little bit about insurance and families using their insurance to pay for this service.

I want to learn more.

Is there also Private Pay or any other way to have this?

Chana Gross:  12:37  

Yeah, so Private Pay is also an option, except that it can get very costly. Most of our families, you know, go through insurance, and insurance now does cover ABA therapy for children with autism. The child will need an autism diagnosis of ASD in order to have the service paid for by insurance. Sometimes we do have parents who have strong suspicions that their child is on the spectrum. They’re going for assessment. They don’t have the documentation in yet. And they will choose to pay out of pocket until that all comes through. And then, once their insurance comes through, then they switch over to an insurance-paid plan, but it is an option. It’s just not an option for everybody to pay privately.

Lisa Ford:  13:24  

Right. Right. I know. I know. 

Chana Gross:  13:28  

Also, it’s really interesting because sometimes, especially, the really, really young kiddos, like, age two or three, we have groups set up in our clinic for like a full day, if you want to say daycare programs, right. I mean, it’s not a daycare program. It’s an ABA program, but it can take the place of daycare for the child. So there’s like small groups of really young children, toddlers, where each child gets a one on one ABA therapist working with them, setting up their goals and making the most of their day. They can get their OT there. They can get their speech there. They get their ABA one-on-one, and it’s a very wholesome program that takes the place of daycare. 

So in terms of financially, you know, if you’re talking about finances, it is a really, really good option because if insurance is paying for that, then you have a program for your child that you’re not paying for.

Lisa Ford:  14:22  

Sounds wonderful. Even the social aspect of it sounds great as well.

Chana Gross:  14:26  

Yeah, absolutely. And it’s like early intervention because, like, you know, the earlier you get started, the better off the child will be.

Lisa Ford:  14:31  

Absolutely. Absolutely. Okay, so our final question for today, Chana.

How much training is provided for families? What would families be expected to independently implement from their child’s therapy sessions at home?

Chana Gross:  14:46  

The answer to that question is, “The more, the better.” Right? So training, like we said, is going to be that once-a-week training, but the more involved the parent is, the more successful therapy is. That’s just what we find across the board. When parents are, for whatever reason, not comfortable with the therapy questioning, if they don’t trust the process, it’s a process and parents who embrace that process and put themselves into it and are curious, and they want to learn, and they want to know, and they are looking to implement, and they observe, then their children come out way ahead. So, it’s just the more, the better.

Lisa Ford:  15:33  

You would say it’s a pretty good idea for them to sit in on a session to make sure they see what’s happening and they get a good feel for it. And then, when the therapist leaves, they can do that on their own.

Chana Gross:  15:45  

Yeah. Yeah. But you know, we do see also that sometimes it’s not practical for parents to do that. They may be working in the next room, and this is their chance to get something done. An adult always needs to be home, so the parent is home during the session. They can come in for snippets of it. They don’t need to sit in on all of it. And even if they’re not there consistently, they’re still getting their training. 

It’s more a matter of perspective and approach. Like, sometimes you have a parent who’s either uncomfortable with the diagnosis to begin with, so they kind of like, aren’t as cooperative or whatever it might be. It’s a partnership. We’re all in this for the success of the child. When a therapist gives a suggestion to a parent, nobody’s pointing fingers. It needs to be understood in the context that this is all for the best of the child. And this is how the child will learn best. 

Lisa Ford:  16:45  

Right. And sometimes, a parent can be a trigger, where the student might not.

Chana Gross:  16:49  

I definitely trigger my kids. 

Lisa Ford:  16:53  

Right. Absolutely. Totally. 

Chana Gross:  16:55  

Oh, yeah. I mean, parents live with their children all the time. It’s not always as easy to be as patient or as consistent. There’s a lot going on, but as parents, we try our best. Yeah.

Lisa Ford:  17:12  

Sounds great. Sounds great. Sounds like a wonderful program. I want to thank you for a great podcast. This is wonderful. What a great resource it’s going to be for our families. 

Chana Gross:  17:22  

I hope so.

Lisa Ford:  17:22  

Yeah, I think it’s going to be great. I will be sure to link your website with this podcast where we’re going to put it up in a few days, and I will make sure to send it over to you.

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If you have a child with autism and you’re interested in exploring ABA therapy, Circle Care Services is the leading ABA service provider in New Jersey. We’re happy to answer any questions you may have, and help you learn more about your options. Contact us today to get started with a free consultation.

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What To Expect As You Start ABA For Your Child

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There are so many unknowns when parents receive a diagnosis of autism for their child for the first time. Your family may notice that autism services are consuming large chunks of your time each week. There are so many responsibilities and lists of professionals that will be in contact with your family on a regular basis. The largest portion of your time will inevitably be dedicated to your child receiving ABA (Applied Behavior Analysis) services, so it’s important to do your research and understand what to expect.

What Is An ABA Therapy Session?

Applied Behavior Analysis is the most widely accepted form of therapy that is recommended and covered by both Medicaid and private insurances. ABA is a data driven and evidence based science that has shown significant success in helping children with autism to communicate, socialize, and learn more effectively. Many young children who receive ABA services are able to attend general education classes rather than special education classes by the time they finish elementary school.

What to Expect During a Session

If you are new to this world of Applied Behavior Analysis, you may be wondering what to expect for your child when it comes to ABA sessions. What exactly goes on during these therapy sessions that makes ABA such a successful form of treatment for children with autism and other neurodevelopmental disorders?

Young Boy Doing A Craft With Oranges At ABA Therapy

Here is the general flow of events that happens when you begin ABA services:

Assessments, Interviews, & Observations

The first thing you could expect when you call a provider to arrange services is that you will be meeting with a Board Certified Behavior Analyst. The first meeting is designed to get to know you and your child and to establish goals for your child to improve behavior, communication, social skills, and daily living skills. Ultimately all of these things will help to improve academic performance as well. The BCBA will make it a point to learn about the child’s family and anyone who is in direct contact with the child on a daily basis. This will help to identify any problems that are hindering basic skills and development. Getting to know the people your child interacts with often in conjunction with a formal assessment of your child’s skills will help the BCBA to determine how to set up a treatment plan to help your child with developing skills and for diminishing inappropriate or difficult behaviors.

I would like to speak with a Board Certified Behavior Analyst.

Recommendation For Treatment

Once assessments, interviews, and observations are completed, your child’s BCBA will submit a report to you and to the insurance carrier. The report will contain recommendations for treatment in order to determine how many hours of services can be provided for your child. The approved hours range from 10 hours per week with many children receiving as many as 40 hours per week. 

ABA Therapy Sessions: In Clinic, In School, or At Home

Sessions can be delivered in a clinical setting if your ABA provider has a location where they offer social skills training and ABA services on site at their clinic. Some families split the hours between school and home visits. Each case is different and every plan is customized to the needs of the child with autism and the family’s needs and schedule. A registered behavior tech will be spending the most time with your child as they deliver the treatment plan the BCBA has written for your child. The BCBA is required to supervise the ABA sessions 10% of the time- or an hour for every ten hours of service provided.

Frequency of ABA Sessions

Depending on the number of hours that your child is approved for, the sessions can take place daily or a few times each week. If your child is approved for 30-40 hours per week, there is a good chance that you will be assigned more than one behavior therapist (registered behavior tech) especially if sessions occur more than once a day. For example, your child may have one registered behavior tech accompanying your child at school for four to six hours during the day, and another tech that delivers therapy at your home in the evenings.

The Relationship Between Child & Therapist

The first couple of weeks of ABA sessions will be focused on developing a relationship between the child and the therapist, known as “pairing”. Pairing is an important part of ABA because without a strong working relationship, the therapist will be unable to control the sessions or expect the child to comply with any of the demands or requests that will be made throughout the sessions.

ABA Therapist Shows Boy To Put Arms In Air

After a successful pairing stage, each session will be activity oriented in a way that utilizes your child’s natural environment and preferred activities. As your therapist embeds instruction into playful activities, your child will be working on improving communication skills, learning appropriate behaviors, and learning replacement behaviors for some of their inappropriate behaviors. For example, a child will learn to ask for help or to take a break instead of destroying a page of math homework to get out of completing the task.

How long and how often are ABA sessions?

Typically, ABA sessions run anywhere from two hours to six hours depending on the circumstances and the settings. It is also dependent on the child and how much they are able to tolerate. When a toddler is doing ABA therapy, they will inevitably need a nap mid morning or mid day (or both), and their nap schedule might limit the times that are open for ABA sessions.

The frequency of sessions may range from twice a week to every day of the week depending on the number of hours that the provider and the insurance company approve.

The more severe a child’s autism symptoms are, the more likely it is to be approved for the higher number of hours each week.

I want to learn more.

What is the best way to prepare for ABA sessions?

Understand The Time Commitment 

The best way for a parent or family to prepare for ABA sessions is to understand how limited personal family time might be. While most families come home from work and school to have dinner, do homework, bathe or shower, and get to bed on time- families with ABA services have to figure out how to manage all of the same necessary tasks with an added member in the family: the behavior tech. It isn’t easy to have someone in your home each day and it can take some time to get acclimated to the idea. Because of the extraordinary number of hours that the therapist will be in your home, it is important that the family and the behavior tech match up well.

ABA Therapist Doing Paper Crafts With Girl In A Session

Parent Training & Education

Be sure to learn all that you can about ABA and participate in the parent training. ABA is only one part of your child’s learning process. ABA shouldn’t stop when the therapist leaves your home. ABA should be taught to parents and caregivers as a skill that continues after the therapy session is over. The best way to assure that is to make sure that parents are familiar with ABA and that they know how to use ABA to teach a child and shape appropriate behaviors while reducing inappropriate behaviors.

When is the best time to start ABA sessions?

ABA should happen as quickly as possible after a diagnosis of autism. Early intervention is the best approach to helping a child with any deficit whether it be a behavioral deficit or an academic deficit. Studies of the effects of Early Intervention Programs that utilize ABA and other professional resources show higher rates of successful outcomes for children who are receiving these services as early as possible after diagnosis. Older children can still benefit of course, but the children who receive services at a younger age tend to be nearly indistinguishable from their peers as they get older.

Circle Care Services in New Jersey is an ABA provider who can help your family to start the right treatment plan for your child. We offer in-home services, preschool readiness programs, social skills groups, and we work in school settings with our clients as well. If you are seeking ABA services and you have questions about ABA, we are here to help.

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