20 Questions to ask ABA therapists

20 Questions to ask ABA therapists

Here are 20 questions you should ask potential ABA providers before you commit to starting your child’s therapy.

 

Click on any of the questions below to skip straight to the deep dive and learn more (printable guide):

1. Can I watch sessions? If I can’t be present in the same room for a clinical reason temporarily, what other means can I observe (i.e., video, zoom, two way mirror?) How often?
2. What ABA methods do you practice (i.e., discrete trial, naturalistic teaching, pivotal response training, etc.)? Do you specialize in one main method or do you practice a variety of methods, chosen and customized to the child?
3. Do you accept my child’s insurance?
4. Do you have a waitlist? If so, how long is it?
5. Do you discourage stimming (self-stimulatory behavior)? Will you try to make my child act “neurotypical?”
6. Are you flexible with scheduling?
7. How are the skills my child will be learning generalized?
8. How can I talk to you, and when will I hear from you? How frequent do you “sit in” on sessions?
9. How often is the facility cleaned and what safety measures are in place?
10. Is there a licensed BCBA on staff? Will they be directly involved in my child’s therapy? Is there a BCBA above my child’s assigned BCBA?
11. What is the BCBA’s background/education?
12. How many cases does the BCBA supervise at one time?
13. How many behavior technicians will be working with my child?
14. What kind of training do the behavior technicians receive before working with my child?
15. How often will my child’s behavior technicians be supervised by the BCBA?
16. Will the behavior technicians working with my child receive ongoing training? If so, what kind and how often?
17. What is your evaluation process and how long does it take?
18. Which assessments are used in the evaluation process?
19. Who handles reauthorizations, and what timeline can I expect?
20. What’s the process for ending/”graduating” therapy?

 

1. Can I watch sessions? If so, how often?

Observing sessions gives you the opportunity to pick up tips and techniques to use at home, as well as advocate for your child if you see any red flags. In fact, parental involvement is one of the biggest factors in your child’s success. If the ABA provider won’t allow you to sit in on your child’s sessions, that’s a red flag. An exception to this would be a clinical reason why temporarily they recommend you observe through another method instead of being in the same room. You should always have some way to observe your child (video, Zoom, two way mirror, window, etc.). For example, if a child becomes more dysregulated when their parent is in the room than outside the room, it may be better to allow staff to work with the child to help them regulate apart from the parent. Then, they can work on incorporating the parent back into the sessions over time. If a provider says you can’t join sessions, ask if it’s just a one time thing or how many sessions it would be, what other ways you can watch, and what the plan would be to incorporate you back into the sessions. You should always be welcome to observe therapy sessions, despite fears it would be a “distraction” to your child. A quality provider will work with your presence, especially if it makes your child more comfortable.

 

2. What kind of ABA do you practice?

Not all ABA is created equal. There are many different approaches to ABA therapy and the quality of providers can vary greatly from depending on the company. ABA is an umbrella term that includes various methods and techniques. Some are more ethical than others, but there is a lot of variation even amongst providers and therapists. (For example, two different ABA providers may practice the same ABA method but in different ways.)

 

The most common types of ABA practiced are:

• DTT (Discrete Trial Training)
• NATS (Naturalistic Teaching Strategies)
• PRT (Pivotal Response Training)

 

It’s important to know which ABA methods a provider specializes in or offers and how they are implemented. You want to ensure that the provider has the appropriate expertise and offers quality implementation in a variety of ABA methods. The methods selected for use with your child during their various programs in their therapy plan should be chosen based on their age, the skill being taught, other diagnoses (e.g., ADHD), and how your child learns best. For example, when people think of “old ABA”, they usually think of DTT. However, one provider may practice “hand over hand” DTT (which is harmful to autistic people) while another provider may practice a more naturalistic, play-based DTT.

 

For example, research shows that a more structured but blended approach using DTT and NATS is most effective with younger children. For older children and specific skill areas, research shows that NATS are most effective at teaching children through their natural routines and play. A red flag to look out for are providers who only use one method for all the children they work with (no personalization or customizing their approach to your child).

 

Ideally, you want to choose an ABA practitioner who uses play-based and naturalistic methods over harsh, rigid ones. Ask potential providers questions like “What happens if my child doesn’t perform a desired behavior?” (For example, if your child is prompted to share a toy or wave to a friend and doesn’t.) You may also want to ask, “What happens when my child does perform a request?” (High fives, praise, treats?) Stay away from ABA providers who rely heavily on tokens (like candy or treats) or those who use punishment of any kind. No therapy provider should ever scold, ridicule, humiliate, use physical punishment, withhold needs, or any other kind of punishment. You want to ensure that your child’s ABA provider aligns with your personal values, and that they’re on the same page with the goals you have for your child.

 

Note: NDBIs (Naturalistic Developmental Behavioral Interventions) like the Early Start Denver Model (ESDM) are often called “new ABA” or “modern ABA” and mesh natural/play-based learning with some ABA concepts. It’s important to know that although ESDM and other NDBIs are sometimes incorporated at some providers, they are not technically ABA.

 

3. Do you accept my child’s insurance?

Your child must be diagnosed with autism and referred by a doctor to ABA therapy in order for insurance to cover it. Some insurance providers cover ABA and some don’t. It’s a good idea to check with your insurance provider first to make sure they cover it. Then, search for ABA providers who accept your insurance. Some providers will not have this information on their website, so be sure to ask. ABA can be expensive, so cost is a factor, especially if you’re paying out-of-pocket or have a copay, a deductible, or a cost share plan.

 

Tip: If you have a copay, make sure to ask if the copays for ABA are per session or per day. If you have multiple sessions in one day, you will only pay one copay for the day under some insurance plans. Others will charge you per session, regardless of the day.

 

4. Do you have a waitlist? If so, how long is it?

Many ABA providers have a waitlist. When you’re screening potential providers, make sure you ask if they have a waitlist and how long it is. Typically, the best providers will have long waitlists, but that’s not always the case (like if it’s a new provider or they have a specific specialization). Afternoon/after school slots tend to fill up the fastest, but keep in mind, the provider you like may have other time slots available and you can migrate to your desired spot later.

 

Here are some waitlist DOs and DON’Ts:

• DO add yourself to multiple waitlists.
• DO check your place on the waitlist often.
• DO respond promptly to emails and phone calls from potential providers when your name is close to the top of the list.
• DO take tours and interview multiple providers to make sure the provider is the right fit for your family.
• DO be flexible with your schedule when getting started. Ask up front, before starting, if your ideal schedule may be possible after a few weeks. (Some providers will allow you to just “get in” and then change your child’s schedule later, while others can’t due to scheduling policies.) Ask if scheduling adjustments can be made later and how often changes to your availability for sessions are allowed.
• DO notify providers if you choose to go with another provider.
• DON’T schedule an evaluation with more than one provider. Insurance will only authorize ABA services with one provider.
• DON’T be afraid to put yourself on all the waitlists for the providers you want.
• DON’T be afraid to follow up with the provider regularly, especially if they are your top pick.

 

5. What are your beliefs on stimming (self-stimulatory behavior)? Will you try to make my child act “neurotypical?”

Stimming refers to the repetitive behaviors (like hand flapping or repeating words) autistic people do to soothe themselves, or just because it feels nice. You should make a point to ask any potential ABA providers what their policy is on stimming. Discouraging or preventing stimming is harmful to autistic people, so it’s important to know a provider’s practices for stimming up front. Note: It is okay to redirect or block stimming if it’s harming your child or other people (like hitting themselves or biting people).

 

You want to ensure that potential providers are not aiming to teach your child to behave more neurotypically (aka “masking”), such as by trying to teach/force things like eye contact or other masking behaviors. The goal of any therapy should be to help your child develop skills that allow them to live a more independent and satisfying life, not to make them appear “less autistic”.

 

If at all possible, your child should be included in goal-setting for therapy. What do they want to do more or less of? What do they want help with? For older children, this includes being included in the discussion regarding how many hours they attend each week, and their start and end dates. Some children with autism want to end ABA before their parents or therapists do — this is a request that should be taken seriously, and used to map out goals and an end date. Making sure your child has a say in their own therapy will empower them by increasing their sense of autonomy, and can prevent unnecessary trauma.

 

6. Are you flexible with scheduling?

Life happens! Is your child’s ABA provider willing to work with you to create a schedule that fits your family’s needs? Are they willing to plan around your existing schedule? What adjustments will you have to make as a family to attend therapy?

 

Some providers are more flexible than others, and each provider will have their own policy about missed or late appointments. Your child may have existing commitments (like school, extra-curriculars, or other therapies) that need to be worked around. Finding a provider who can work with you to create a schedule that works for your family is important. You also don’t want to overwhelm your child with long therapy hours, too many activities or appointments, as that can lead to burnout.

 

A quality, affirming provider will compromise with you to create a schedule that works with your child’s needs, the family’s existing schedule, and doesn’t cause the child burnout or distress. If your child does burn out, the provider should work with you to address your child’s needs and accommodate them.

 

7. How are the skills my child will be learning generalized?

Generalization refers to how skills your child learns in ABA will transfer to other people, other places, and the real world. It is one of the critical components of quality ABA and success with ABA therapy.

 

Generalization is usually incorporated in two ways. The first way is to teach generalization while the skill is being taught. For example, a child is taught to request juice by saying, “juice” with their behavior technician. However, before “juice” can be marked as being learned, the child will also need to learn how to say “juice” with his mom, his dad, at a restaurant, with different brand/containers of juice, etc. The second way to teach generalization involves teaching the child to say, “juice” with the behavior technician at home and marking it as learned/mastered. At that point, they start teaching another item for the child to request and they open up a new program to specifically work on teaching the child to generalize “juice” with other people, in other places, and with different examples/brands of juice.

 

All ABA therapy plans should include a section for generalization of skills and how to maintain them. Some insurance companies require the ABA provider to include this section, and some don’t — but a high-quality ABA provider will include it regardless. You may want to ask, “Is generalization taught while my child is learning the skill or is it taught later? How do you generalize what they have learned so that they can do it with other people, in other locations, and with different items or examples?” This will give you a better idea of how the provider teaches generalization.

 

Note: Autism is a dynamic disability; that means your child may be able to do something one day and may simply not be able to do the same thing the next day. But don’t worry — it doesn’t mean they’ve “lost” a skill! It means they might still be learning the skill or just having a hard time.

 

8. How can I talk to you, and when will I hear from you?

Communication is a vital part of any service your child receives. You’ll want to know when you can communicate with members of your child’s ABA team, how often, and what mode of communication (email, text, phone, etc.) is best. How often will you be able to check in or voice concerns? What is the length of time for a response? In case of emergencies, how will you be notified? You want a provider who has ongoing open communication with you and is available to answer your questions. Do not be afraid to contact them to tell them your needs, concerns or ideas — be direct! They want to help and be a good match for your family’s needs. You shouldn’t have to chase down your child’s BCBA or team members to talk about your concerns.

 

9. How often is the facility cleaned and what safety measures are in place?

Let’s face it — kids are messy! Put a bunch of kids together, and it can quickly become Germ City! Ask potential ABA providers how often they clean their facility and how often they sanitize toys, tech, doorknobs, and more. Some ABA clinics outsource their cleaning to cleaning companies who come in daily or nightly. Some will rely on staff to keep things tidy, or a mixture of both. Check out the facility during your tour and make note of the facility’s cleanliness. Since Covid-19, RSV, and other illnesses are transferred by touching surfaces or the air, keep an eye out on your tour to ensure staff is keeping up with safety regulations and the facility is well-maintained. Ask if they have a sick policy and health screen/checklist.

 

You will also want to pay attention to safety measures in place at the facility — do they have keypad locks? Where are the exit and entry points, and how are they accessed? What’s their visitor policy? Are their outdoor areas fenced? Is the clinic located near a busy road or body of water? This is especially important if your child is prone to elopement (running away).

 

10. Is there a licensed BCBA on staff? Will they be directly involved in my child’s therapy?

Medium to large ABA providers should have more than one BCBA on staff. A small ABA company may only have one BCBA on staff. Some people refer to themselves as “behavior therapists’’ or “behavioral consultants’’ — this is NOT the same thing as a BCBA. BCBAs (Board Certified Behavioral Analysts) are required to have certain education, take an exam, and are licensed by a national board. Some states require an additional license, LBA (Licensed Behavior Analyst) on top of the BCBA licensure. Note: You can find licensed BCBAs in your area by searching here.

 

If your funding source allows it, your child’s team may include a masters level manager who is working toward their certification. This person works directly under your child’s BCBA and in conjunction with them to provide supervision to your child’s case (i.e., your child will have two supervisors on your team). Some of these managers may be BCaBAs (Board Certified Assistant Behavioral Analysts). BCaBAs require supervision by a BCBA at all times. If there is no BCBA providing monthly supervision to your case, this is a red flag. BCaBAs, managers or supervisors should NEVER be supervising cases on their own without a BCBA.

 

You want a provider who can ensure that your child’s BCBA will be directly involved in your child’s therapy, not just tucked away in an office somewhere. A quality ABA provider will have a close-knit, heavily involved team who are spending time working with your child one-on-one.

 

11. What is the BCBA’s background/education?

BCBAs can come from all types of backgrounds, such as speech therapy or education. Some BCBAs even begin as Behavior Technicians and work their way up. Feel empowered to investigate the BCBA’s experience and competence. Just because someone has a BCBA credential does not mean they are a quality provider or the best for your child! It’s okay to be picky when choosing who will work with your child.

 

Some points you may want to bring up when interviewing a potential BCBA for your child:

• How many children have you worked with?
• What type of profile are you most experienced with? (Nonverbal children, children with learning disabilities, children with aggressive behaviors, highly verbal, etc.)
• How many years have you been in the field?
• What is your take on neurodiversity?
• Why did you want to get into ABA therapy?
• Who supervises you? (There should always be someone more senior above the BCBA that they can go to for support and provide supervision to your child’s BCBA and case oversight.)

 

12. How many cases does the BCBA supervise at one time?

The BCBA assigned to your child won’t just be working with your child. They typically carry a caseload of 10–15+ kids at a time. You want a provider whose BCBAs manage cases on the lower end of this range. Any more than 16 or 17 and BCBA’s will burn out fast. This leads to high turnover for the provider, which can directly affect the quality of your child’s therapy. BCBAs who have high caseloads will not be able to deliver quality service to your child. This should be considered a red flag.

 

13. How many Behavior Technicians (BTs) will be working with my child?

It’s very common for your child to have more than one Behavior Technician working with them. Some clinics tend to rotate Behavior Technicians to prevent burnout and to get kids used to other staff members in case their assigned BTs are not available. Rotating Behavior Technicians promotes generalization as long as it is not done too frequently. Too few could leave you in a tough spot if someone calls out and it limits generalization of skills (i.e., your child will only be able to do the things they learned with only the one BT who works with them). The number of BTs recommended will be based off the number of direct therapy hours your child is prescribed. The higher the hours, the more BTs will be assigned to your team. For example, a child receiving 30 hours of ABA per week might have 3–4 BTs on their team. A child receiving 16 hours per week might be assigned 2 BTs on their team.. Of course, the ABA provider may have to rotate new people in if there are scheduling conflicts. If at all possible, the staff member responsible for scheduling and assigning Behavior Technicians should pair your child with the people they work with best.

 

14. What kind of training do Behavior Technicians receive before working with my child?

Behavior Technicians do the day to day activities of therapy with your child. They’ll record data and observations from sessions and receive instruction from the BCBA. The minimum qualification to become a behavior technician is a high school diploma or GED and a clean background check. It’s important to know that “Behavior Technician” is an umbrella term that covers a variety of background, education, and skill levels. There are different types of BTs, some with certifications and some without. Some will have more education and training than others. The amount of training and education a BT has will depend on the insurance company/funding source, and the provider’s company policies.

 

Behavior Technicians should receive 40 hours of training before receiving their certification. Although some people complete the training and don’t choose to test for certification. It is an entry level position, meaning they will be trained on just the skills needed. Because turnover is so high for Behavior Technicians, low-quality providers will hire with little to no experience or training and put them in sessions with children immediately. This is why it is crucial to ask about the quality and content of the training they provide. Do they offer classroom training? How long is it? What is taught? Do they offer field training to practice those skills with children? If so, how long is it? What is the criteria to pass? Since BTs will be the staff members your child interacts with most, it’s really important that you ask potential ABA providers what training they receive before they’re allowed to work with your child.

 

15. How often will my child’s Behavior Technicians be supervised by the BCBA?

Your child’s Behavior Technicians will likely be the members of their team you interact with the most. Depending on your insurance, and whether or not your behavior technician is certified as a RBT, BCAT, ABAT, QASP, etc., they may be required to receive a minimum percentage of supervision for total hours worked. For example, if your child’s Behavior Technician works a total of 100 hours in a month with all their clients, at least 5 of those hours should be directly supervised by the BCBA. The type and frequency of supervision will vary depending on the BT’s certification and the provider’s supervision policies. As we mentioned, you want to make sure you find an ABA provider who has heavily involved BCBAs. Behavior Technicians typically receive only entry level training, so ensuring your child gets a quality experience will depend on the BCBA observing, working with your child, adjusting their care plan, and offering feedback to the BTs.

 

An ABA provider who does not provide adequate supervision for their Behavior Technicians is a red flag. (This may be more common with in-home ABA.) The amount of supervision is partially dependent on the amount that your funding source authorizes for your child. The BCBA guidelines suggest 2 hours of supervision for every 10 hours of therapy, but not all insurance companies follow this rule. Generally speaking, the more direct therapy hours your child receives, the higher amount of supervision hours will be authorized. The authorized supervision amount is used for a variety of supervision tasks, and some BCBAs are more hands-on than others. The golden rule is: the more supervision, the better!

 

16. Will the Behavior Technicians working with my child receive ongoing training? If so, what kind and how often?

Ask potential ABA providers about their training procedures for Behavior Technician. For example, are they trained on updates and changes to your child’s care plan in a prompt manner? Are they being taught best practices? Do they role play with the BCBA or sit in on sessions and observe the BCBA in action? Are they required to attend any additional training or classes? Given that Behavior Technicians are “on the front lines” of your child’s therapy sessions, you’ll want to investigate if they’re being trained and prepared to deliver quality services to your child.

 

17. What is your evaluation process and how long does it take?

The evaluation process will take place after you select a provider for your child’s ABA therapy, but you want to get a feel for what that process will be like before committing to one. Evaluations will usually include assessments, collecting data from your family and your child’s background (medical, family history, school, etc.), interviews with you, and observation time with your child. All of these pieces of information will help the BCBA create a plan for your child’s therapy. It’ll help them determine which goals to focus on, and brainstorm strategies that might be best for working with your child.

 

Your child’s BCBA will also use this information as a “baseline” to show where your child is starting from, so they can track their progress. Some providers may complete their evaluation anywhere from 1–4 weeks, so be sure to ask how long it takes. Note: Your child’s start date may not be immediately after the evaluation is complete. Sometimes there’s a gap between evaluation and actually beginning therapy, while you wait for your insurance company to complete the authorization. If your child’s evaluation takes longer than 4 weeks, or if your child can’t start therapy yet due to staffing issues, that’s a red flag.

 

18. Which assessments are used in the evaluation process?

Some common assessments an ABA provider may use are VB-MAPP, Vineland-lll, ABLLS, and AFLS. The provider may have a preference for one over the other, your insurance company may require a specific one, or the company may have their own preferred assessments they like to use. You can expect to fill out a few assessments, some of which will have to be readministered every 6 or 12 months to get your hours reauthorized. These reassessments measure your child’s progress and learning. It determines if the therapy is successful, as well as if your child had been prescribed the right amount of hours. If your child has challenging behaviors (like hitting or self-harm), there should be an FBA (Functional Behavior Assessment) included as well. An FBA can consist of many things, including observation, interviews with parents and teachers, and additional assessments like Functional Analysis Screening Tool (FAST) and Motivation Assessment Scales (MAS). The results are used to create a behavior intervention plan based on the “function” (or reason) behind your child’s behavior. This plan is like a cheat sheet with strategies and instructions for everyone to handle the behavior when it happens.

 

Note: Don’t be afraid to ask the BCBA or contact person to explain each assessment (and its purpose) to you. Some assessments can feel really critical of parents or bring a lot of worry about your child’s future. Remember, assessments are just a snapshot of how your child is doing on a certain day and time, and so many factors can affect the results (i.e., hunger, sleepiness, an unfamiliar person observing them, their routine being disrupted, etc). Assessments are NOT the final say on who your child is or who they will become!

 

19. Who handles reauthorizations, and what timeline can I expect?

An insurance authorization will be required before your child can begin therapy (if you’re paying with insurance). This means the person in charge of the insurance authorizations at the ABA provider will submit your child’s case plan, assessments, graphs, and anything else needed to get the plan approved by your insurance. Your insurance company will have to reauthorize your child’s ABA services, usually every 6 or 12 months. Recertifying every 6 months is ideal because it allows your child’s team to assess their progress and work with you to make changes, figure out what’s working and what’s not — things like that. You’ll want to get the name of whoever is in charge of reauthorizations for the ABA provider. Sometimes the BCBA will handle reauthorizations, and sometimes the ABA provider will have a designated person to handle them. Ask what the timeline is for reauthorizations and what you can expect. You’ll be required to sign off on reauthorizations as well as complete updated assessments as needed. It’s important all these tasks are done in a timely manner so that your child’s therapy is not interrupted.

 

20. What’s the process for ending/“graduating” therapy?

How and when to end ABA therapy is an important question to bring up when speaking to potential ABA providers. The length of your child’s ABA therapy will depend on your child’s wishes, their therapy goals, and of course, many other factors. A good way to ask a potential ABA provider is “When will we know it’s okay to stop ABA?” or “How will we know when it’s over?” A quality ABA plan should outline the criteria for graduation and an individualized “discharge” plan. The ABA provider should be able to provide a road map of the individual skills your child will learn to meet the overall ABA goals you’ve set. They should provide updates on your child’s progress, then based on the time frame it usually takes your child to master skills, use that to estimate when all your child’s goals will be met and therapy can be discontinued. If the ABA provider has no clear end in sight, that’s a big red flag.

 

Note: You may also want to ask about the provider’s policy for “pausing” therapy. Life happens, and it’ll be helpful to know what your options are in case your child needs to stop therapy for a while. If you are considering a pause in therapy because you feel your child is not making progress, schedule a meeting with your BCBA and request them to perform an assessment of your child’s case to figure out what’s causing the issue. They should be able to figure out what’s affecting your child’s sessions and implement a plan to make changes (i.e., BT needs additional training, reinforcement needs to be changed, programs need to be changed, etc.). If you want to pause therapy for other reasons, please know that regression (your child appearing to “lose” skills they previously mastered) is common.