by Jessie Cooper | Apr 8, 2020
Over the last several weeks, our country and world have changed more than I believe we ever imagined. Each person and business has had to rethink what our new “normal” looks like because of COVID-19. For the autism community and ABA (applied behavior analysis) providers, one aspect of our new normal is telehealth.
I can say with confidence that very few BCBA’s or ABA providers were savvy to telehealth prior to COVID-19. Telehealth was used on a very small scale in regions that are remote and therefore barren of service providers. Outside of these outliers, we are a face to face field. So what do we do with this new service delivery model? How can we as service providers use telehealth for ABA to help our clients and their families get as much access to care as possible during COVID-19? At Instructional ABA Consultants (IABA) we’re approaching this in a few different ways. I also think from a mom’s perspective there are several aspects I would personally consider if it were my child. I’d like to share both.
Telehealth at IABA Consultants
To start, at IABA we first had to consider the clinical standards we want to see for all of our clients. It’s one of our core values that clients make progress every week. In eight years of business, I know this piece has always been true for us. Our data speaks volumes. With COVID-19 I knew as the owner I was willing to approve new policies to support our families so long as this value held true. I hold a great deal of trust in our team of directors and followed their guidance to ensure clinical quality.
Now please remember that we are essential workers and many of our clients are receiving direct care with supervision via telehealth. The reason for all supervision being by telehealth is to decrease the number of people gathering (#socialdistancing). There is a portion of our clients whose families are choosing not to have ABA providers in the home during Shelter in Place. For these families, we created three options for telehealth to address the variety of clients we serve.
Telehealth Options at IABA Consultants
The first option is for our clients who can independently respond (understand conversation through technology). In this option, we are doing direct telehealth sessions with them. This option allows clients to get the same content of their ABA session over video sessions.
The second option for our clients who can learn via telehealth, but cannot respond independently, is to require a moderator (family member) to assist during telehealth sessions. During telehealth sessions with a moderator, the ABA therapist will send over data sheets & materials prior to the session then coach the moderator on how to run goals.
The third and final option is for clients whose families are either not opting into any type of direct session (one on one goal work) either in person or via telehealth. This option is also available for clients who BCBAs do not feel their programming is appropriate for telehealth (remember our value of progress!). This third option consists of weekly or bi-weekly parent training sessions. During these parent training sessions the BCBA reviews goals, provides materials, datasheets, and trains the parents on their child’s ABA programming.
All of these options provide a spectrum of care for our clients. With ABA therapy we know that the amount of hours impacts learning and behavior reduction. One sacrifice that is made via telehealth is that hours are reduced so the speed of progress will slow. However, the benefit here is that for all families who are opting out of ABA therapy in the home, but into telehealth, progress will not stall and their child will not significantly regress.
I like to think of telehealth options as a good fitness program. When you are able to go to the gym and get goals from your trainer you will most likely make steady progress toward your goal. If the gym is not available and you’re now jogging outside you’re still making progress, but it’s not as fine-tuned as the gym. It’s progress, as you stay fit, but maybe you lose 2lbs instead of 5lbs this month. Telehealth tailored to our clients is like a really good jog and I’m beyond grateful for the response of the insurance providers to make this an option.
Telehealth from a Mom’s Perspective
Now, as promised, I want to take a moment to talk about telehealth as a mama. If my children were receiving this service I know that there are two things that would be important to me. The first piece I would want is for the telehealth session not to act as a babysitter. I would want my child to be actively learning not sitting and zoning. I can turn my own TV on. To monitor for this I would make sure the BCBA on the case was overlapping these sessions (also remotely), updating data, and providing weekly summaries of learning.
The second piece I would be mindful of is how much time my child is spending with the telehealth option. As I said above, ABA therapy improves outcomes based on the amount of time a child receives therapy each week. I don’t think this is true for telehealth. I would be wary as a mama if my service provider still wanted to do 40 hours of ABA via telehealth. At IABA we’re looking at between 30 minutes to an hour at a time based on the learner. These can be multiple times per day but eliminates the worry of just keeping a screen on all day with no progress. If both of these pieces (progress & length) were monitored for my child I would feel at ease with telehealth as a short term solution.
I hope the way IABA is approaching telehealth and my views as a mama serve you. We’re all in this together and together we’ll all be stronger for it.
Xoxo,
Jessie
by Jessie Cooper | Mar 25, 2020
Over the course of the past week, our lives have changed rapidly. Here in Illinois, as in many states, we are formally following Shelter in Place. ABA therapy is medically necessary for children with autism and ABA therapists are categorized as essential workers. That being said, we gave our families and staff the option to pause services or work until the Shelter in Place lifts on April 7th in Illinois. We gave the same option to our Colorado families. There are still families receiving services and staff working, but we have more families currently on pause than those continuing with ABA therapy (as a personal choice). As a clinician and mama who is now going on week 2 home with my own children, I know how hard it can be. This week I’d like to provide some insight on simple tips for children with autism who are at home without their usual support team.
Tip #1: Make a Daily Routine
I know that this tip sounds simple. I’ve even seen this tip on several parenting sites not specifically meant for children with autism. Having a daily routine during a time when life feels uncertain can be comforting. It’s also an easy way to ensure you are doing what’s important for you and your children every day.
For children with autism, routine has been, and will be, important beyond the COVID-19 outbreak. People who have autism often think in patterns and sequences. Life itself is one big pattern! To a person with autism, knowing what comes next can bring down anxiety levels. If anxiety is low, problem behaviors surrounding a change in the routine (the next task on the schedule) are less likely. The more predictable you can make each day for your child with autism, the calmer they are most likely to feel.
Tip #2: Single Task
I’ve mentioned this before, but in “How Not to Lose Your Shit with Your Kids,” single tasking is brought up A LOT. Maybe after COVID-19 the book will be a New York Times best seller! Just kidding. But in all seriousness, if, while you are implementing your child’s (or children’s) daily schedule, you are trying to multitask you are setting yourself up for failure. Single tasking is just what it sounds like. Do one thing at a time.
With millions of us now working from home, while our littles are there as well, I know what a large feat this is. You are trying to work and keep your children happy, which is multitasking in itself!
How I’ve personally tackled this is by setting up my children’s schedule (minus naps & food) around my day. What this can look like is taking breaks from work to transition your children through their schedule. It may look like cutting yourself some slack and when you really need to work. Things like putting a movie on or setting up play time that you don’t need to be involved in may seem like sub optimal parenting. While I know the mom guilt can be real, knowing our own boundaries makes for a calmer house. Do one thing at a time the best you can to keep your nervous system at bay. If you do lose your shit, go ahead and give yourself a great big mental hug. It’s OK, we’re all struggling.
Tip #3: Choose Small Goals
I learned this tip working with children with autism well over a decade ago. I was working with a boy with autism back in Ohio and he had a goal to learn to shower independently. In order to learn the full task of showering we broke the skill of showering into small steps. The goal was broken down into steps like taking clothes off, turning on the water, checking the temperature, and so on so forth. The whole process was over 25 steps! We taught one step at time and, in time, he learned to shower by himself. In ABA we do this for all our clients in their programming.
While you’re home with your child with autism, pick a few goals that are really important to you–ones that will bring pride or joy to your child. These goals can be new communication (pick 2-3 words/signs, communication cards), play goals with siblings, play goals alone, eating goals, or self care. Think about things you’d like your child to be able to do. Observe your child and write down all the steps they would need to know in order to accomplish the full goal. From there, you’ll pick the first step of the goal. Teach, teach, teach until that first step is learned. After you see success on the first step, move to the next. You may not get to the full goal by the end of Shelter in Place but your child will be learning!
Comment on our Facebook post your questions about goals and we’ll reply!
Tip #4: Celebrate Success
It’s so easy to become frustrated with each other during Shelter in Place. I mean, we’ve all seen the Shining… Staying in place can be filled with wonderful family moments, as well as some pretty real human moments. To help your child with autism know what they are doing well, make it a point to praise them! Try to find 10 positives a day to praise your child. Knowing that they are doing something correctly gives your child the confidence to continue their positive behaviors. And hey, while you’re at it, maybe thank your husband or wife for dumping clothes in the hamper not the floor.
Tip #5: Remember Functions of Behavior
Over the course of the winter, I wrote about the functions of behavior. I explained how everything happens for a reason and how in ABA we use four categories to explain why behavior happens. These categories are attention, escape, access to tangibles/activities, and automatic. During your time at home with your child, if a problem behavior occurs start to observe it the best you can to find the function. Here’s a quick guide:
- Attention: Parent is busy-problem behavior occurs, parent provides either positive or negative attention
- Escape: Parent requests-behavior occurs, parent removes demand
- Access: Child requests an item or activity-behavior occurs, parent gives access
- Automatic: this one is complicated, please reference my previous blog here
Once you notice what your child wants with their tantrums or problem behavior, it’s important to do two things. First, try to be preventative and fill them up with what they want before the behavior occurs, when feasible (for escape this is lots of breaks/attention & access is self-explainable). Then, if the problem behavior still occurs, do not give your child the consequence they are seeking. You don’t want to reinforce bad behavior. Stay consistent and sooner, rather than later, your child will realize the behavior isn’t working and it will go down. Also, remember to teach language skills to help your child request their needs more safely!
Tip #6: Give Yourself a Break
Life is disrupted for pretty much everyone right now. It’s easy to start your day with a plan only to have that plan change–sometimes only minutes into the day! It could be from work, your child’s particular mood at the moment, or that you yourself are just having a bad day. Try hard not to judge yourself and instead provide grace. Say kind things to yourself when you’re struggling and make sure you’re carving breaks out for yourself. These should be things you love to do. Mine look like naps, a kid-free hour, and running. If I’m overwhelmed I look to when I can schedule a me moment in. I hope you can too.
Xoxo,
Jessie
