Home or School Based Therapy?


As a supervising therapist on our IBI/ABA caseload and a teacher at our private school, I have a unique perspective on the delivery of ABA. Having just graduated from a Masters in counselling psychology, and having completed a 400+ hour practicum in CBT for kids with ASD, I have yet another discipline to pull from. Here is my clinical formula: teacher + supervising therapist + CBT therapist= many different schools of thought.

Before founding Magnificent Minds (MM), I worked in both education and early intervention; I worked in private clinics and private schools respectively. In every occasion, I felt like half of the puzzle was missing. In schools—even in specialized schools, I felt the need for a clinical supervisory team like what I had experienced in early intervention. In clinics—I was longing for the group learning dynamic, the traditional school-like atmosphere, and the possibility of age appropriate social skill development for kids beyond the preschool age.

Fast forward ten years and I am sitting in the director’s seat at MM; I have amalgamated two different worlds...the clinical and the academic/scholastic. I am fortunate to wear all my hats to one special occasions; but, enough about me—how does it impact the kids I support?!

I supervise the therapeutic programs for clients in a variety of situations:

1. IBI therapy DFO funded (on-site)

2. ABA therapy privately funded (on-site)

3. ABA therapy privately funded (off-site)

People always ask me my opinion on the home vs. on site debate; my response is always the same. If at all possible, opt for on site...cue gasp...I know, it is not always a popular response and believe me I understand the concerns parents are facing (logistical, financial, emotional, personal, and so on).

Some may not agree, and I welcome scholarly debate, but let me state my case.

1. First and foremost, kids with ASD (the primary demographic I service) possess social and communication needs; though communication can be targeted anywhere (in theory) the environment in which it is targeted (and it’s set up to cite just one factor) is highly relevant to the success of the intervention. Social skills need several factors to be targeted effectively; they need a social partner and circumstances which elicit social behaviour (to cite just two factors).

Whenever I provide a therapist (which is every application of ABA/IBI) you automatically have a social partner; but what about circumstance? When therapy occurs in centre, the circumstances which elicit social interaction are naturally occuring; the items we have chosen, the play equipment, the materials literally require social interaction.

Even in the fanciest of houses, with the most elaborate set ups—it is difficult to compete with the naturally occurring social situations which occur in our sensory gym, our play rooms, or our playground.

So now some are thinking, ok so if I set up a sensory gym, a play room (which I already have) and install a play structure in my backyard...then is home based therapy more feasible? My response...feasible...yes, beneficial...sure....but equal to what will occur on site? Not in my opinion.

2. The second dynamic that is unique to a school based IBI/ABA therapy provider is the exposure to social interaction; the ‘p’ factor (p=peers).In a comprehensive ABA/IBI program (ABLLS-R) there are entire domains allocated to social interaction, generalization, group instruction, and classroom routine. It is not impossible to target these domains at home, but it’s downright easy (and natural) to target them in a school based environment.

So now some are thinking, ok so if I set up a sensory gym, a play room (which I already have), install a play structure outside, make a mock classroom, and invite some neighbourhood kids to play (the ‘p’ factor, right?)...then is the therapy more feasible?

My response...feasible...yes, beneficial...sure, but equal to what will occur on site? Not in my opinion.

WHY!? You exclaim, right?

3. In a school based IBI/ABA program in addition to the myriad of factors named above, you also have the factor which cannot be replicated any way you slice it—we’ll call it the ‘s’ factor (the school factor).

Think of the big picture; what’s it all for? We put all our time, energy and money into early intervention so that we can ensure our kids have the skills they need to thrive in later environments; what’s the later environment? School!

So, given the deficit in skill transference (generalization) one way to actively pursue generalization of skills from therapy to real world is to practice them in the context they will actually occur in; enter, the ‘s’ factor.

One of the major concerns people have with ABA is its ability to produce authentic/organic, non rote, learning which transfers to other circumstances or contexts. In isolating the therapeutic and academic environments, even when there is collaboration between team members, there is always the risk that skills won’t generalize. When therapeutic and academic environments come together, it is possible to actively plan for skill transference in a way that supports both short term and long terms goals. If we forget where we are going (i.e. a school base environment of some kind) it is difficult to effectively plan the best route to get us there!

Imagine driving to grandma’s house, but not keeping in mind where you’re going. You would drive around for hours and hours (and spend lots of money on gas), and never get any closer to grandma!

Every family is unique and so is their circumstance; for some, it is literally impossible for therapy to occur onsite anywhere—whether it’s geographical circumstances or individual variables which prevent accessibility.

Any way you seek therapy for your child is commendable, but I encourage you to consider your child’s individual needs and consider whether the ‘p’ factor and ‘s’ factor may contribute to his or her success in getting to the final destination—whatever that may be for your child.

Cheers!

Alley



Phone:  647-404-6349 OR 647-985-7001  
Email: MagnificentMindsToronto@Gmail.com

 

Toronto Campus: 37 Southbourne Avenue - School Wing, Toronto, ON
 

Vaughan Campus: 9600 Bathurst St. - Kimel Education Building, Maple, ON

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