EARLY INTERVENTION

• In 2010, the NJEIS began the process of requiring providers to select, train, and utilize a specific curriculum designed for children with autism spectrum disorder. While an ABA-based curriculum was not required, many agencies took an ABA approach to the curriculum and selected resources such as the VB-MAPP, Rethink, and the Eden Curriculum. Policies regarding implementation and training are thus far agency specific.
• When therapists have been assigned to a child with autism or a child who needs an ABA-based curriculum or approach, they should use the agency-approved curriculum. They should also find out procedures for assessment, collecting and reporting data, and how decisions regarding program changes are made.
• Ideally, each agency should have a supervising BCBA in charge of these cases who strives to ensure that all therapists are using the agency-approved curriculum and procedures.
• Therapists should collaborate with others on the team to make sure that they are following the same curriculum and plan. It is helpful to share materials via a notebook left in the home or a computer-based file-sharing system.
• Any concerns regarding consistent implementation among team members should be discussed with the child’s service coordinator as well as a therapist’s own agency supervisor.

• If a therapist is working with an agency outside of NJEIS, he/she should obtain parental consent to communicate with other agencies and practitioners using NJEIS form-009 “Parent Consent to Release Early Intervention Records“. The therapist should indicate specific conditions such as permission to email and permission to collaborate on ABA program implementation.”
• Create a note in the Early Intervention Management System (EIMS) that parental consent was obtained. Create a note each time communication is made between agencies. Keep a copy of any text or emails for the child’s file for parents to view as required in the NJ EI System Code of Conduct
• The EI team should make an effort to co-treat with the other agency and/or increase team meetings (BACB Task List 4th edition, item G-06).
• The supervising BCBA who is coordinating the ABA program should determine if the teaching procedures and curriculum used by more than one agency are complementary. If there are conflicts that can’t be resolved, discuss with the family and service coordinator to determine if sharing the case is in the best interest of the child.
• Use common language when EI practitioners and families are not familiar with ABA terminology. (See BACB Task List 4^th edition, item G-04) Compose or modify programs so they are conceptually systematic and able to be performed uniformly by all practitioners.
• Communicate with the other agencies to determine which programs are being implemented and which agency is keeping copies of program records and related data.  It may be helpful for the agencies to decide which specific areas each will target and coordinate; for example, a provider working through insurance may be coordinating programs for skill acquisition, and the EI agency may be working on generalizing these skills within the home and community. These roles might also be determined by practitioners’ specific areas of expertise so that they are able to provide training and guidance. Some areas for training may include: mand instruction, discrete trial instruction, social skills, feeding, desensitization programs, daily living skills, and maladaptive behavior.

State-funded services for children birth – age 3 are provided by the New Jersey Early Intervention System (NJEIS) in partnership with the Regional Early Intervention Collaboratives (REICs).

Be able to describe your professional obligations and any challenges and obstacles you encounter.

Inform your supervisor and agency leadership of current ethical code for supervision. Discuss how the agency can support you in maintaining your ethical obligations and how sessions will be scheduled to promote supervision.

Ask your agency to review the Professional and Ethical Compliance Code for Behavior Analysts with all BCBAs, BCaBAs, ABA therapists and members of the interdisciplinary team to ensure understanding of and compliance with all supervision-related responsibilities.

Use a combination of direct supervision, data review, and data collection on parents’ implementation as well as generalization checks to meet the supervision requirements.

Supervisors and supervises should communicate a plan for meeting the supervision guidelines and how they will be tracked for each client.

Hold Individual Family Service Plans (IFSP) meetings more frequently than the typical review period of every 6 months.

“Co-treats” – having the child’s session with another therapist. Some regions of the NJEIS discourage same-discipline co-treats, and this may need to be addressed with the agency.

Personal communication with team members through the communication log with all therapists, the program book that remains at the home, email, text, online document sharing, etc.

Speak to the service coordinator regarding this concern. Express the need to be consistent in providing effective ABA services and that ABA programs should be delivered consistently between therapists on a team.

Behavior Analyst Certification Board (2014). Applied Behavior Analysis Treatment of ASD: Practice Guidelines for Healthcare Funders and Managers, 2^nd ed. Author: Littleton, CO.

Howard, J., Sparkman, C., Cohen, H., Green, G, & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.

Chasson, G. S., Harris, G. E., & Neely, W. J. (2007). Cost comparison of early intensive behavioral intervention and special education for children with autism. Journal of Child and Family Studies, 16, 401-413.

Use an evidenced-based parent training model during your sessions to help guide the process and keep the family focused on the goals at hand. This may include using written guides that can be referred to from one session to the next to help focus the parent.

Use principles of applied behavior analysis when interacting with parents and caregivers. Use a task analysis to give caregivers small steps that they can build upon once they have success. Use differential reinforcement and praise for all attempts at carrying over a suggestion and offer feedback and support to make modifications in the future to guide those attempts towards success.

Incorporate behavioral skills training by discussing a skill or strategy, modeling the skill or strategy and then having the caregiver practice the skill or strategy while you observe. Give praise and or feedback in the moment and go back to modeling the skill again if necessary. Continue on in this manner until the caregiver can successfully demonstrate the skill or strategy. Make sure to follow up at your next session as to how the caregiver has been doing when you were not there. Ask them to demonstrate the skill or strategy for you again so that you can ensure successful implementation and offer ways to then build upon that skill.

Take a step back and look at the big picture, what is most important for this family and how can you make an impact in that area. If a family feels successful in even the smallest of ways, they will be more likely to follow your future suggestions.

The NJEIS is a family training model and parent training should therefore be incorporated into all services.

• Focus on goals that are meaningful to the family and can be incorporated into routines outside of sessions.
• Provide the family with direct instruction regarding how to implement research-based strategies with their children.
• Incorporate parents as an active participant in sessions while providing coaching and feedback.
• Shape parents’ behavior by initially selecting strategies and goals that are easily attainable and easy to implement. This way the parent can access reinforcement through success.
• Speak to the service coordinator about including family training as a billable service. This will allow the therapist to work with the parent outside of direct instruction with the child. The therapist will then be able to spend more time familiarizing the family with behavioral principles and providing opportunities for discussion and behavioral skill acquisition.
• See resources regarding behavioral skills training and parent training protocols such as Optimistic Parenting: Hope and Help for You and Your Challenging Child

Use an evidenced-based parent training model during your sessions to help guide the process and keep the family focused on the goals at hand. This may include using written guides that can be referred to from one session to the next to help focus the parent.

Use principles of applied behavior analysis when interacting with parents and caregivers. Use a task analysis to give caregivers small steps that they can build upon once they have success. Use differential reinforcement and praise for all attempts at carrying over a suggestion and offer feedback and support to make modifications in the future to guide those attempts towards success.

Incorporate behavioral skills training by discussing a skill or strategy, modeling the skill or strategy and then having the caregiver practice the skill or strategy while you observe. Give praise and or feedback in the moment and go back to modeling the skill again if necessary. Continue on in this manner until the caregiver can successfully demonstrate the skill or strategy. Make sure to follow up at your next session as to how the caregiver has been doing when you were not there. Ask them to demonstrate the skill or strategy for you again so that you can ensure successful implementation and offer ways to then build upon that skill.

Take a step back and look at the big picture, what is most important for this family and how can you make an impact in that area. If a family feels successful in even the smallest of ways, they will be more likely to follow your future suggestions.