If you’ve recently entered the world of applied behavior analysis (ABA), you’ve likely heard the word “quality” quite a bit. In some ways, it’s the buzzword in ABA. Providers are eager to talk about quality, eager to demonstrate how their organization provides quality services, while funders and other stakeholders are equally eager to ensure that providers uphold these standards.
As a parent of a child either ready to start ABA services or already receiving them, the word “quality” can be confusing. You might find yourself uncertain about what to look for amidst all the jargon and promises. But don't worry – this confusion isn't solely yours. The field of applied behavior analysis, particularly as it relates to autism, is still relatively young compared to other fields. Consequently, we haven't yet established a universally accepted definition of "quality." So, any uncertainties you have stem from the broader ambiguities in the field, not from a misunderstanding on your part.
So, what exactly does "quality" mean, if we lack a universal definition?
In ABA, discussions about quality generally revolve around two primary aspects: the processes organizations implement to ensure consistent, effective care, and the outcomes that result from these processes. When providers discuss quality, they often refer to clinical measures such as treatment integrity, programming audits, and safety evaluations. These measures help ensure that services are delivered according to best practices.
On the outcomes side, organizations may reference scores on standardized assessments, such as adaptive behavior scales or measures of cognitive development¹. While these quantitative measures are crucial, it's important to recognize that they may not capture the whole picture of what quality means in practice.
So how can you identify quality in an ABA organization?
While some indicators are measurable and objective, many other elements contribute to quality and are often under discussed. As a parent, consider the following key factors:
- Strong Communication Mechanism: Does your behavior analyst foster open, clear communication with you about your child’s treatment?
- Responsiveness: When you reach out to the organization, do you receive timely and thoughtful responses?
- Opportunities to Provide Input: Are you given chances to share your thoughts and feedback regarding your child’s treatment?
- Partnership in Treatment: Do you feel involved in the course of treatment, or is it presented to you as a directive?
- Safe Environment: Is the center clean, organized, and free from potential safety hazards?
- Structure and Systems: Are there established procedures and systems in place that guide how sessions are conducted?
- Supervisory Presence: Are supervisors present and available on-site consistently?
- Management Involvement: Is the management engaged with parents and staff, demonstrating leadership and support?
- Calm and Welcoming Environment: Is the environment inviting and calming for your child?
- Staff Focus: Do the staff appear dedicated and focused on meeting the needs of your child, rather than being overwhelmed by other responsibilities?
To assess whether a specific organization meets high-quality standards, ask yourself the following questions:
- Do I feel comfortable discussing my child’s treatment with my behavior analyst?
- When I reach out, do I receive a thoughtful response in a reasonable timeframe?
- Is it clear who I should approach with concerns or questions?
- Do I have the opportunity to provide feedback regularly?
- Is my feedback taken seriously and integrated into treatment adjustments?
- Does my team solicit my input during treatment planning?
- Is the center organized and devoid of safety hazards?
- Are supervisors frequently present and engaged with the staff and clients?
- If I connect with other leaders in the organization, do they respond?
- Are there structured systems ensuring oversight and consistent treatment delivery in sessions?
- Is the environment calm, and does my child express enjoyment in attending sessions?
- Do I feel positive about bringing my child to therapy?
- Do the staff appear to enjoy their work and focus primarily on the children?
- Is there evidence that staff receive support to handle administrative or operational tasks effectively?
As you explore different ABA services for your child, it’s crucial to reflect on these questions and factors. Understanding quality in ABA is more than just numbers or assessments; it encompasses the relationships built, the safety provided, and the environment cultivated for our children. Your child's well-being deserves high-quality care, and as a parent, you are a true partner in ensuring that quality is prioritized. Interested in learning more about how we address quality in ABA services at Mindcolor? Contact us today!
Author: Amber Valentino, Psy.D., BCBA-D, Chief Clinical Officer at Mindcolor Autism
References
¹Joseph, A. et al. (2024). Development of a standardized set of outcomes for autism spectrum disorder: The International Consortium for Health Outcomes Measurement (ICHOM). Research in Autism Spectrum Disorders, 117 https://doi.org/10.1016/j.rasd.2024.102451.