By: Alexa Toevs M.Ed., BCBA
As a parent, your schedule can be pretty tight. Between work, getting the kids to and from school, and participating in extra-curricular activities, it can feel overwhelming to find time to add another pick up/drop off spot to your agenda: your child’s therapy.
When starting Applied Behavior Analysis (ABA) therapy, choosing where sessions will take place is often a contributing factor in choosing your child’s therapist. While location is certainly not the only component of choosing a good fit for your child’s therapy, the setting where sessions take place can be just as important as the therapy itself. Your child’s rate of learning may actually be influenced by the setting where the service is performed!
Lets discuss some of the considerations that Home-Based vs Clinic-Based ABA therapy may include.
First, what is your child’s level of need, and how many hours a week were recommended by the treatment team? When thinking about this consideration, ask yourself if you’re prepared to have people in your home for that amount of time. Conversely, are you able to get your child to a clinic for that amount of time?
Second is your schedule. Do you have a flexible work and personal schedule? Can your schedule be adjusted to accommodate the amount of therapy needed? If you can’t make those adjustments, the therapeutic benefits won’t be there. Questions to ask yourself here might be if your home setting allows you to do laundry while your child is with the therapist? Or, does dropping off at the clinic allow you to run to Target while child-free? Imagine which setting could work into your schedule most easily.
Similarly, consider location factors. Is the clinic close by your home? What errands could you complete near the clinic? Would a therapist be willing to travel to you? What are the charges for traveling to your home? If your insurance covers therapy, you might ask if travel charges are even covered?
Finally, what are the goals of therapy? What skills will my child need to work on? Are they skills that can be taught in the home? For example, if a major area of focus is self-care issues, those may be easier to address at home and harder to address at a clinic. On the other hand, if one area of concern is social skills, you’re going to need your child to have access to other kiddos! Think about efficiency. While most skills can be taught in either location, which setting would be most efficient to work on teaching those skills?
One way to make the best choice for you and your family is to create a pros and cons list. Your individual pros and cons may vary, but let’s go over a general overview.
Pros and Cons of Home-Based Therapy
Pro number one is the convenience of being a part of the session and observing what your child is learning. Having a therapist in your home provides more opportunity for you to ask questions and learn the strategies that are being used so that you too can practice these skills with your child when the therapist is off-duty.
Another pro for home-based therapy is practicing skills in the same environment where they are usually performed. This would speed up the therapy process and require less effort in generalizing the skills that would be most often performed at home. Skills would likely be mastered more quickly because your child would practice their new skills in the environment where they will use them the most!
Now let’s look at some commons cons for home-based therapy.
Therapy at home can be distracting for kiddos and not always therapeutically productive. Home life doesn’t stop when therapy starts. There are still siblings around, a barking dog, or phones ringing. It may be convenient to have a therapist come to you, but it may not be what is the most comfortable for all of your family members. Having a new person in the house is something for everyone to get used to and it may not fit into your family’s lifestyle. We all know the feeling of having guests over, so it may feel like more work having to keep the house neat and tidy to prepare for the therapist to come.
Pros and Cons of Clinic-Based Therapy
Now let’s look at some pros of clinic-based therapy. Think of a clinic-based approach more like a lab. This is a good thing! A controlled, structured therapy practice is promoted during clinic-based treatment, which means the therapist has much more control over the learning environment. Everyone is there for the same reason. Kiddos are hard at work, and therapists are able to limit distractions which allows for complete focus on skill-building practice.
Another big pro for clinic-based therapy is peers. If social skills are a priority, a clinic offers many more opportunities for social interaction with kids similar in age or ability to your child.
Having easy access to your case manager is another win in clinic-based treatment. It is very easy for the supervisor to assist and support the therapy process when you’re physically in the clinic. The BCBA (Board Certified Behavior Analyst) has more opportunity to spend time training the Registered Behavior Technicians (RBTs) while in the clinic. The BCBA is able to observe more kiddos traveling on foot from room-to-room rather than driving from home-to-home. Time is better spent in one location rather than traveling around the city!
However, every rose has its thorn and clinic-based therapy is no exception. Between working, cooking, and keeping up with the schedules of activities, who has time for transportation? Carpool usually isn’t an option as therapy is typically one-on-one. It’s unlikely that you will have friends who are also heading to ABA therapy after school.
Another con may be tired kiddos. After school, kids are hungry, tired, and not really up for being anywhere but in the comfort of their own home. It can be hard to convince them to spend time doing more learning after their brains have worked hard all day at school!
Bonus information: Therapists in the classroom
Another option for therapy if you don’t want to choose between education and behavioral support is having a therapist come to school with your child. This option can vary in time and cost based on need of the child. A therapist could spend a whole day or just a few hours with a child during their school week.
The good thing about having the extra support of a therapist in the classroom would be the one-on-one attention that is provided. The teacher could continue with the lesson and the therapist can manage any behavioral struggles that occur. Although, it can take some convincing to get a teacher on board with having another person in their classroom. As always, good therapy practice requires open communication with all parties involved. The therapist and the teacher need to build good rapport for in-school therapy to be effective.
All-in-all, deciding where your child gets ABA therapy is often based on a combination of convenience and availability. Sometimes you can get the best of both worlds with an option to split therapy time between your home and the clinic for weekly sessions. When beginning your child’s therapy, make sure to discuss any thoughts or concerns with the case manager so you all can build the best foundation for your child.
Still have questions about what ABA even is? Check out our last blog, “What is ABA? Myths, Facts, and Who it Can Benefit.” Wanting some parenting tips? We also recommend “7 Strategies for Teaching Resilience.” We also share tips and parenting activity ideas over on our Instagram and Facebook pages!
References: Dixon, Dennis R.; Burns, Claire O.; Granpeesheh, Doreen; Amarasinghe, Roshan; Powell, Alva; Linstead, Erik (2016). A Program Evaluation of Home and Center-Based Treatment for Autism Spectrum Disorder. Behavior Analysis in Practice, (), –. doi:10.1007/s40617-016-0155-7
