Many families touring center-based programs are given a tour of the facility and offered numerous brochures. However, most of these materials do not contain enough information for families to make an informed decision as to whether or not a program would be appropriate for their child and their family. Some of the information that would be useful to families includes, 1) Information regarding the staff at the center, 2) How treatment goals are chosen for a child, and 3) How a child who is making progress in treatment would be addressed as well as a child who is not making progress in treatment.
To get the information that you need about the many components of center programs that can vary from program to program, it is wise to ask some pointed questions.
Clarify how the program defines family-centered practice
As has been stated before, confirm that the center is “family-centered” by finding out whether they implement mechanisms for scheduled caregiver coaching and whether parents are included in writing goals for their child. Find out whether parents’ ideas are written down and become part of their child’s treatment plan.
How does a program develop treatment goals for a child? Who writes them and do families sign off on them prior to their implementation? Are assessments of children viewed as clinical pieces of information that are handed to families after an assessment or are treatment goals for children developed based on the daily routines of importance to families that have been identified as difficult by families?
Specific prompts worth using
- How many caregiver coaching sessions are scheduled per month, and are they billed separately or bundled?
- Which assessment tools are used, and how often is reassessment conducted?
- What happens to the plan if a family priority conflicts with a clinician’s recommendation?
- Is any portion of the program delivered in the home or community, and under what conditions?
Ask about the therapy format, not just the therapy label
Just because two programs use the term ABA does not mean that they are identical. In terms of the individual child, look at the ratios of therapists to children, the number of hours of one-on-one work in comparison to group work and how that will change over time, and the amount of time spent on structured skill instruction in comparison to time spent in natural environments where the skills will be required. Look at a sample daily schedule for the program your child would attend.
The number of hours of 1-on-1 work versus group work that your child will receive on an individual and increasing basis over time and why that decision was made for your child and how that decision will change for your child over time.
Comparing common delivery formats
| Format | Typical strengths | Questions to press on |
| Center-based, one-to-one | Controlled environment, consistent staffing, easier data collection | How do skills transfer to home and school settings? |
| Center-based, small group | Peer modeling, routine practice, social opportunity | How are groups composed, and who supervises them? |
| Hybrid center and home | Generalization built in, caregiver involvement is structural | Is travel time billed, and who coordinates across settings? |
| School-adjacent or consultative | Aligns with educational goals, lower weekly hours | How is information shared with teaching staff? |
Ask how supervision and staff continuity are managed
Ask the proportion of supervision hours that a child receives in relation to the hours of skill instruction that child receives. These hours of supervision can be provided by an individual or several supervisors. The child could also receive these hours of supervision in live sessions with the child or by reviewing previous session data.
In terms of staff turnover, it would be good to know how many therapists a child has had in the last year and how the program handles a therapist leaving. Most quality programs have multiple steps of transition for a therapist leaving a child.
Credentials and oversight
- Confirm which staff hold certification and which are working toward it.
- Ask how often the supervising clinician directly observes the child.
- Request the process for raising a concern about a specific staff member.
- Ask whether session notes are available to parents and in what format.
Press on measurement, review, and exit planning
What data does the center use to track children receiving ABA services? What specific data points are measured? How often are the progress graphs reviewed for a child and what would prompt a program to switch to a different approach when a child is not meeting their goals?
Transition planning and discharge can look very different from provider to provider, and families comparing options in Rhode Island would do well to see how established teams such as Providence ABA therapy services structure that process. What families want to know is what reduced hours of services would look like, how that would translate to a school-based setting and vice versa. Most programs outline this in a formal document and review it with families.
Setting realistic expectations
Many parents search for a program and a provider who has predicted exactly what will happen with their child in the future and can provide services and meet outcomes for their child. What parents really need to know is that a quality program describes how the individualized goals for a child will be measured on an ongoing basis and how often the family will review the treatment goals for their child with the program.
Weigh logistics against clinical fit
It is also important to note that there are many practical constraints to a family’s ability to attend a center program. These may include the time of day, the length of time of sessions, the distance of the center from the family’s home, other family members’ schedules, the family’s illness policy and the center’s holiday schedule as well as the authorizations for the funding stream of the family.
Are additional hours of service available and does the program escalate when attendance is below the number of authorized hours for a child?
