One of the questions I get asked the most is whether in-home or clinic-based ABA therapy is best for my child. After all, autism impacts all aspects of a child's life. The short answer is that it depends on the individual. Let’s dive into some of the attributes of each model to determine a framework to use when deciding treatment. As always, our Board Certified Behavior Analysts (BCBAs), in consultation with you and your child, will be able to assist you in determining which service model best fits your child.

What is Home-Based Therapy?

Home-based therapy is provided in a 1:1 setting between the Registered Behavior Technician (RBT) and the client.  If a client receives all of their sessions at home, a Board Certified Behavior Analyst (BCBA) will also attend and participate in sessions on a frequent basis to provide supervision and support.  

A parent is present during each session and is able to observe their child and be involved in the treatment plan.  The opportunity to engage in parts of the session help provide hands-on opportunities to work with your child.   If you are interested in learning how to apply behavioral strategies with your child when a RBT is not present, a home-based setting may be a great option.

Based on individual need and funding, home based therapy can also mean assistance in the community. It provides a way to implement treatment at the park, grocery store, or other locations where there is need. This allows at home to not just function in a single environment, but across the natural environments in which your child engages on a daily basis.

Home-based therapy allows for a greater focus on day-to-day skills, such as brushing your teeth, eating meals, and potty training.  If your child is struggling with everyday, functional skills, a home-based setting may be the most appropriate option.  

In addition, the home provides a good setting for skills learned in a more controlled environment to be generalized.  What we mean by the term ‘generalization’ is that the same skill can be applied in a broad collection of settings.  The consistent application of a particular skill across new environments demonstrates true aptitude and command.

What is Clinic-Based Therapy?

Some children with autism are destructive to property or demonstrate aggressive behavior to others or themselves.  A clinic may be an option in these cases as it reduces environmental variance to allow more focused treatment for challenging behaviors.

Clinics generally have other children receiving therapy during your child’s session.  This facilitates more opportunities for your child to socialize with other kids, and the ability to attend group therapy.  If your child needs a greater focus on social skills, a clinic may be a good option.  A clinic provides an environment that more aptly prepares children for school.  The sessions tend to be at set times and include the repetition of going to a location to learn.

Therapists can rely on each other for input and collaboration relating to their clients.  Each child is different and requires an individualized approach.  Having additional clinical perspectives allows for new ideas and a broader set of experiences to address certain situations.  

Sometimes parents schedules are too busy to facilitate home-based treatment.  A clinic is a good option for parents or caregivers who lack the time each week to be present during each session.  It can also provide periods of calm for the broader home structure.

What Should I Do?

One thing that helps some parents is to write out a pros and cons list in order to determine what may be the best fit for your family.  Provide this information to your BCBA and they can use it to help you find a solution that works best for your family.  

Research indicates in-home ABA services combined with clinic-based services results in greater persistent gains.  Where, how, and who provides services are determined on a case by case basis in order to ensure the highest quality outcomes based on each individual’s needs and each family’s circumstances. At Galliant, we aim to generalize skills so our clients can apply what they learn to a broad set of situations.

You can ensure that, wherever your child receives therapy, you will be heavily involved in their treatment.  Studies have demonstrated parent involvement and training decreases familial stress while improving child outcomes and broader family functioning.  Your child will receive excellent clinical care in either setting.  If you still have questions, feel free to contact us at help@galliantcare.com.

References

Registered Behavior Technician.  Behavior Analyst Certification Board

Home-Based Vs. Center-Based Services for Autism. Forbes