For years, people on with Autistic Disorder - or Autism Spectrum Disorder (ASD) - have participated in home-based therapy. The concept behind home-based treatment is that it helps to facilitate behavioral intervention in the natural environment. For example, if a teenager is working toward the independent skill of doing laundry, they can practice with a counselor using their own laundry room and their own clothing. For many goals, home-based intervention is an important route to take.
Yet more and more, providers are moving toward other environment to facilitate interventions - such as the child's school, the community, or even specialized centers. According to the Association for Science in Autism Treatment and Board Certified Behavior Analyst, Mary Jane Weiss, this is due to the increasing number of autism diagnosis per year and the efforts of schools to facilitate interventions for as many children as possible. While we can speculate why more interventions are leaving the home and moving into the community and centers, we do know that there are many benefits to center based services.
At Autism Family Center in the Greater Chicago Area, interventions are done across the board - at home, at schools, and at the center itself. However, specialty programs have been developed to create center-based interventions. Director of Behavior Analysis, Leighna Fischer, BCBA, explains six benefits to providing center-based programs for children on the autism spectrum.
The Environment Itself Provides Structure
When children work on their goals at home, the intervention usually includes a goal and a reinforcement... but that's it. A child may sit at a table working on their individual target and each time that they do a good job their behavior is reinforced. They continue back and forth like that with their therapist until their session time is up.
When programs are provided in the center, the staff have the ability to create a structure and a routine. They can even have the environment mock a classroom. This can be particularly helpful for young children who are not yet ready to go to school. While the child works on goals like learning letters and numbers, they can also practice moving through the routine of being in school (e.g., participating in circle time, craft time, etc).
For school-age children and teenagers, this quality of center-based services is beneficial after school - particularly for those whose aberrant behaviors increase due to lack of structure in the afternoons.
The Ability to Contrive the Environment
The environment does not only provide an opportunity for structure but also facilitates the ability to contrive situations not otherwise possible at home. To understand this, let's look at a specific situation:
Let's say Scott is learning to trace letters. When Scott sits alone with no distraction he is able to complete an entire tracing assignment. However, when his brothers - Todd & Josh - come running into the room he is unable to complete the task, gets frustrated with his brothers, and has a very hard time returning to the task after Todd & Josh finally leave.
At the center, the therapeutic team would address this by creating a very controlled environment. Scott would first be asked to sit in a room that had absolutely no distraction and complete his letter tracing assignment. Slowly, the team will introduce distractions. They may start by playing very soft music and work with Scott on coping skills to work through the distraction. Once Scott can complete the letter tracing assignment with soft music, the team may decide to play louder noises or even the soundtrack of other voices. They will continue like this as Scott learns to complete his assignments with added levels of distractions.
Generalized Skills Across People and Consistency with Current Relationships
In a home based setting, kids are exposed to the same people over and over again - namely their parents, siblings, and the therapists who visit them. However, by participating in center-based care, they are exposed to novel people every day - such as new children and other therapists. The therapists who aren't assigned to their case can jump in to help facilitate the generalization of new skills across multiple people. This means that a child who learns to be compliant with their therapist will also learn compliance across situations and relationships to encourage compliance in all matters.
On the other hand, this also encourages consistency within relationships. In other words, a parent can just be a parent. The parent does not have to be the parent, the tutor, the therapist, etc. A child goes to the center to participate in therapy and can associate their home and their parents with a place of relaxation while maintaining the skills they learn in therapy.
Academic Opportunities
Through center-based interventions, therapeutic teams are better able to assess and teach prerequisites needed to function appropriately in a classroom such as sitting in a chair, attending to the speaker, attending to activities placed in front of them, following directions, transitions, routine, schedule following, etc.
As mentioned above, contriving the environment, allows therapeutic teams to better teach academic skills because they are able to create an environment that truly mocks the classroom setting. Unlike at home, staff can make sure that preferred activities are completely unavailable until a child has completed the academic task they are resisting. At home, preferred activities are readily available and often create distractions. Additionally, when therapists withhold preferred activities, they can take the place of the "bad guys" so that parents are free to enjoy their family time without enforcing nonpreferred academic tasks.
Benefits to Counselors and Therapists
For many years, Autism interventions - specifically Applied Behavior Analysis (ABA) - has been done one-on-one in the home. This means that a therapist arrives at the home and works solely with the child for about 3 hours then usually goes to a different household to do something similar with another child. The process can be very isolating and, unsurprisingly, ABA has one of the highest turnover rates of any industry. At the same time, ABA is an industry that relies heavily on a reduction in staff turnover in order to promote therapeutic success. In other words, children who regularly experience a change in therapists, may not be fully experiencing the benefits of an ABA program.
The perks of providing services in a center-based setting extend beyond the child to the staff - which in turn benefits the child. When staff feel they have a team to rely on, they are less likely to feel burned out and thus less likely to quit. These same therapists are more likely to feel fulfilled at work which increases their dedication to the job. Through center based services, kids have access to more dedicated and satisfied therapists and benefit from the consistency in therapeutic relationships.
Children Working Together Present Social Opportunities
When many children are at one location together, there is obviously an added social opportunity - that is an opportunity for them to interact with each other. Socializing can be particularly challenging for kids and teens on the autism spectrum. When working with their counselors, at home, kids may role play various social situations or discuss bullying at school. However, at the center, the kids can practice these things with one another.
Many of the kids we see at Autism Family Center display resistance during their first few days of center-based services. Many will immediately decide that they don't like one another. Working through this, however, is part of the goals that many kids have. Over their first few days, we start to see them accept the "annoying" behaviors of other children. Over the weeks they will develop friendships. And, among our teens, we even see them talk about the bullying they have experienced with one another. As the staff, we get to watch them discover that they have had a lot of experiences in common. It's extremely rewarding.
By working with - and simply near - other children, the kids who work at the center are exposed to opportunities like: working as a group, peer-to-peer interaction, peer-to-peer learning, turn taking, waiting their turn to speak, engaging in conversation, and more.
To learn more about center based services at Autism Family Center, visit the Programs Page, or contact Lauren Rabin laurenrabin@autismfamilycenter.com or Leighna Fischer lfischer@autismfamilycenter.com.
Co-Author and Contributor Leighna Fischer, BCBA: Leighna Fischer is a Board Certified Behavior Analyst and the Director of Behavior Analysis at Autism Family Center. Leighna has been working with individuals on the spectrum for over 10 years. She considers herself a Radical Behaviorist and a Chicago Bears enthusiast.