Updated: Aug 25, 2022
My article on red flags in ABA providers generated a great deal of interest from caregivers and clinicians in the ABA field. Those red flags include potentially harmful practices that parents, caregivers, and providers should be aware of.
Through my 13 years in the field, I have seen firsthand the tremendous things that ABA can do for the clients we serve. Even more in the last few years, as clinicians have listened to the voices of those we serve and subsequently made changes in their practices. ABA has incredible potential for positive change. As such, I want to highlight the amazing work many practitioners in the field are doing.
As you pursue an ABA provider for your child or for employment, consider these GREEN flags! These signs indicate ethical and effective practices.
Each individual we work with is unique in their strengths, needs, and interests. Programming straight from an assessment or based on a cookie-cutter curriculum does not benefit the learner. To teach socially significant skills, we should be creating each goal unique to exactly what the learner needs. If a provider values individualization, that's a green flag in my book!
2. Honoring Assent Withdrawl
Since our learners typically are not able to provide consent, we gain consent from parents and caregivers. However, we should still be ensuring that our learners are providing assent for therapy. I encourage everyone to seek employment or therapy with providers who understand assent and honor assent withdrawal. Does the provider force follow through or allow modifications when assent is withdrawn? Furthermore, does the agency train its employees on assent and assent withdrawal? If so, green flag!
3. Balanced BCBA Caseloads
The size of a BCBAs caseload is likely to depend on many factors including the number of direct hours they're supervising for each case, the complexity of each case, and other responsibilities. BCBAs who have caseloads that are well balanced may be more likely to provide effective case oversight. BCBAs who are overworked with high caseloads are more likely to become burnt out and unable to provide adequate supervision, thus resulting in poor outcomes for both clients and RBTs whom they supervise.
I can't necessarily provide an exact "acceptable" caseload size for everyone, as it will greatly depend on the BCBAs experience, other non-billable responsibilities, the complexity of cases, hours, and more. My recommendation, however, is to ask a potential provider what the BCBA caseload is like and consider the overall expectations of the position to determine if the BCBA is likely to provide adequate supervision and oversight with the caseload size.
Consider that funding sources often require 10-20% BCBA oversight, so if a child is receiving 30 hours/week, a BCBA needs to provide 3-6 hours of supervision. This does not include parent training or re-assessment. Providers who ensure appropriately sized caseloads are a definite green flag!
4. Parent Training and Support
ABA is most effective when skills and behaviors generalize to the people that matter most for the individual-Family! Teaching caregivers to implement strategies that have proven effective during therapy sessions is vital in a child's ongoing improvement. Providers who value parent training and support their staff in the development of training caregivers are another green flag!
5. Naturalistic Teaching
There is nothing innately wrong with sessions that are DTT-based, especially when provided with children who thrive in that setup. However, naturalistic teaching provides so many opportunities for generalization and facilitates an enriched and enjoyable therapeutic setting. For that reason, providers who prioritize naturalistic teaching strategies are a green flag! This goes back to point #1 though-Individualization! There should never be a one-size-fits-all approach. If a child learns better through discrete-trial training, that is a-okay!
I consider BCBA-owned agencies a green flag! BCBAs are ethically obligated to abide by the Code of Ethics set forth by the BACB. Therefore, the policies they create and enforce should (in a perfect world) align with ethical and effective practices. I don't intend to claim that ABA companies not owned by BCBAs are unethical or less likely to provide effective care. However, I do believe that an agency owned by a BCBA is more likely to advocate for and train their employees on best practices, with a stronger focus on quality of care, as opposed to increasing revenue.
This is not an all-exhaustive list. There are so many amazing clinicians out there doing great work in the ABA world. Keep advocating for effective and ethical care!