What Families Should Know About Our ABA Policies at Progressive Steps

Starting ABA usually comes with a lot of questions that have nothing to do with the actual therapy goals.

What happens if your therapist gets sick? Can you ask for a different therapist? What if you need to take a vacation? Who supervises the program? Are you charged every time the clinical team changes something? What happens if you disagree with a recommendation?

These are reasonable questions. And families should know the answers before they commit to services.

At Progressive Steps Training & Consultation Inc. (PSTC), families receive our full policies, procedures and service agreement before beginning ABA. They are detailed because therapy is a relationship between the client, family and clinical team, and everyone should understand what they are agreeing to.

This post explains those policies in more everyday language.

How our ABA service model works

Our ABA programs are supervised by Registered Behaviour Analysts in Ontario and supported by senior clinical staff.

Depending on the number of hours and complexity of the program, a client's team may include a Clinical Supervisor, Senior Therapist, Lead Therapist and Therapist. This allows the person delivering the direct therapy to have regular access to more experienced clinicians for coaching, problem-solving and program changes.

We follow the professional and ethical standards that apply to behaviour analysts in Ontario. We also expect families to understand that good ABA is not simply a therapist arriving at the house and running the same programs week after week. Treatment needs to change as the person learns, circumstances change or the data tells us something isn't working.

What families can expect from our approach

A few values run through many of our policies.

We use evidence-based teaching approaches and monitor progress closely. If something isn't working, we adjust it.

Clients and caregivers are part of the treatment team. Families should know what we're working on and why, and clients should be involved in decisions about their treatment as much as possible.

We also want therapy to feel safe and respectful. We prioritize self-advocacy over compliance, provide choices, and pay attention when a client's behaviour is telling us that something needs to change.

And we don't target differences simply because they look different. For example, we don't teach someone to stop stimming unless that behaviour is creating a barrier to another goal that matters to them.

Starting services and how our waitlist works

The first step is a consultation. This gives us a chance to learn about the client, what the family is looking for and whether our services seem like an appropriate fit.

Families then receive our intake forms, policies and service agreement through our secure client portal. Once those are completed, we can move toward an intake and goal-setting meeting when an appropriate service opening becomes available.

One thing families sometimes don't realize is that our waitlist is not strictly first come, first served.

We match openings based on things like the client's needs, the number and timing of hours required, location, clinical complexity and therapist expertise. After-school and evening times are usually more difficult to accommodate than daytime hours. Clients with more complex needs may also wait longer if the available therapist isn't appropriately trained for their program.

Having an opening isn't enough. It needs to be the right opening.

How we choose a therapist

We don't assign therapists based only on who has space in their schedule.

We consider the therapist's skills and experience, travel time, existing caseload and professional development needs. We also consider the client's needs and the needs of other clients already receiving services.

We will only accept a client when we believe we have a team with the skills and qualifications to meet their needs.

We also don't necessarily expect a client to work with only one person forever. Learning to use skills with different people is part of generalization, which simply means being able to use what you've learned outside one specific situation or with one specific therapist.

What's included in your ABA session rate

This is probably one of the most important parts of our service model.

When a family pays for ABA at Progressive Steps, they aren't only paying for the hours when a therapist is sitting beside their child.

Our session rates are designed to include the clinical work normally required to run the program properly. That includes;

• direct 1:1 ABA,

• clinical supervision,

• individualized treatment planning,

• program updates,

• data review,

• documentation,

• therapist coaching,

• caregiver meetings,

• collaboration among clinical team members,

• communication with other professionals,

• treatment summaries,

• safety planning when needed and

• ongoing quality checks.

Clinical supervision can also include;

• observing therapy,

• reviewing programs before they're introduced,

• reviewing Individualized Service Plans,

• meeting with therapists about progress or barriers, and

participating in caregiver or professional meetings when appropriate.

Some supervision may take place virtually when that makes clinical sense.

It is very unusual for us to bill separately for routine clinical work. If we find that a client's program consistently requires substantially more clinical time than what is built into the service, we discuss that with the family first. Consent is obtained before additional billable clinical work is completed.

We structure things this way because quality ABA needs some flexibility. A therapist may need extra coaching. A program may need to be rewritten. We may need a longer conversation with a parent or another professional. Those things are part of providing therapy well, not extras that should be avoided because no one wants to trigger another bill.

Supervision and complex programs

Supervision happens throughout services, not only at a scheduled review every few months.

The clinical team may observe sessions, review data and notes, coach the therapist, make program changes, meet with caregivers and discuss barriers to progress.

Some clients naturally require more clinical involvement. This may be because of the intensity or complexity of challenging behaviour, complex programming, community-based goals or programs involving Acceptance and Commitment Training.

A client may begin with more intensive clinical support and move to a less intensive model when appropriate.

When therapists change

We work hard to maintain a stable team, but we can't promise that one therapist will stay with a client indefinitely.

Families receiving services from Progressive Steps are working with our clinical team, rather than hiring one specific staff member.

A therapist may leave the organization, move into another role, change caseloads or eventually need a change after working with the same client for a long time.

Sometimes the clinical data may also suggest that another therapist would be a better fit.

When a planned change happens, we don't simply hand the program to a new person.

The new therapist may receive training outside the session, complete shadow sessions, have the previous therapist observe them, and receive increased supervision during the transition. They begin working independently once the team and the client's progress indicate they're ready.

Families are not charged additional amounts for the shadowing and transition support described in this process.

If you're concerned about your therapist

We want families to tell us!

A concern might be frequent cancellations, poor rapport, limited engagement, an increase in concerning behaviour during sessions or simply that progress has stalled.

Changing therapists isn't always the first answer. Sometimes the therapist needs more training, coaching or clinical direction.

If those steps don't resolve the issue and a therapist change is appropriate, we can look at a different match. We can't always promise that another appropriately qualified therapist will be available immediately, so in some situations a family may need to wait for another opening.

When our staff cancel

Therapists get sick and emergencies happen.

If your therapist needs to cancel unexpectedly, they notify you and the senior member of the clinical team.

When it is clinically appropriate and another team member who knows the client's programming is available, that person may cover the session. If appropriate coverage isn't available, the session is cancelled.

Sessions cancelled by our team don't count against a family's grace days ( more info below).

Family cancellations, grace days and vacations

We know children get sick, family events come up and people need vacations. At the same time, ABA relies on reasonably consistent attendance.

For unexpected illness or another unforeseen situation, we ask for at least three hours' notice. Sessions cancelled with less notice are billed according to our cancellation policy.

Families also receive grace days for cancelled sessions. These are based on approximately 10% of scheduled sessions over a year.

A client attending once per week receives five grace days per year. Two sessions per week provides ten, three sessions provides sixteen, four sessions provides twenty-one, and five sessions per week provides twenty-six.

Once all available grace days have been used, additional cancelled sessions are billed according to the policy, even when notice is provided.

For vacations of one week or longer, we ask for at least two weeks' notice.

An extended therapy break means more than two consecutive weeks without scheduled sessions. A family may use available grace days, continue paying to hold the schedule, or place therapy on hold. If services are placed on hold, we cannot guarantee that the same spot will still be available when the client returns.

When someone is sick

For in-home ABA, families should use the cancellation process when the client or household is ill.

If significant symptoms develop during a session, including fever, vomiting, diarrhea or flu-like symptoms, the session may need to end early.

For centre-based services, participants with a fever, vomiting or a contagious condition should stay home and can return after being symptom-free for the required period without medication.

Injuries and incident reports

If an injury happens during therapy, we document it and review it with the caregiver.

We also ask families to tell us about injuries that happen outside of therapy when they could affect the person's participation. A sprained ankle, for example, may change what we're able to do during a community or movement-based program.

Diversity, equity and inclusion

We work with clients, families and staff from many different backgrounds.

Discrimination based on race, culture, gender, religion, sexual orientation, disability, accent or lifestyle is not accepted within our services.

Therapist assignments are made based on education, training, experience and clinical fit.

Racism, discrimination, harassment or hurtful language toward clients, families or staff may result in a session ending and the concern being reviewed by the Clinical Director. These expectations apply during sessions and in emails, texts, phone calls and other communication.

Program materials

We provide program materials that can reasonably be reused or shared among clients.

Families may be asked to provide or purchase items that are specific to one person and cannot be reused. Examples include individual workbooks, some craft supplies, toys or games that stay in the family home, and oral sensory or personal-care items.

Families can purchase those directly or, when arranged, we can purchase them on their behalf.

Consent, assent and client choice

Consent isn't something we get once and then forget about.

We consider whether the client is able to understand the treatment being proposed and its possible effects. When a client can provide informed consent themselves, we obtain it directly.

When a parent or guardian provides legal consent, we still involve the client whenever they are able to understand what is happening.

For someone who cannot legally consent but can understand aspects of treatment, we seek assent. That means explaining the therapy in a way they can understand and paying attention to whether they agree or disagree.

Consent and assent are reviewed over time, particularly when treatment changes.

Parent and caregiver participation

For children and teens, caregivers are part of the treatment team too.

We expect parents to know what is being worked on, participate in meetings, respond to communication, ask questions when something is unclear and take part in caregiver training when appropriate.

We also ask families to share information that could affect therapy. That may include medication or diet changes, a new recommendation from another professional, a major change at school or something happening at home.

Families may also be asked to practise strategies between sessions when doing so will help the client use a skill outside therapy.

Professional boundaries

Our team members don't provide private services to PSTC clients outside their role with Progressive Steps.

That includes things like babysitting, respite or privately arranged ABA outside the organization.

These boundaries can sometimes feel strict, especially when a family has developed a strong relationship with a therapist, but they protect the client, family and staff member from conflicts of interest.

Personal hygiene support

Some clients need help with toileting or other personal hygiene.

Staff can provide that assistance when it is needed, appropriate consent has been obtained and the client's privacy and dignity can be respected.

Phones, tablets and laptops during therapy

Our staff use electronic devices during sessions.

They may be accessing the client's file, collecting data, completing documentation, reviewing programming or communicating with the clinical team.

If you're ever concerned about how a device is being used during your child's session, please ask the Senior Therapist or Clinical Supervisor rather than wondering whether the therapist is doing something unrelated.

If you have a concern or complaint

We encourage families to raise concerns early.

Usually, a clinical concern starts with the Senior Therapist. The Clinical Supervisor may then become involved, and we may hold a meeting with the family and treatment team to agree on an action plan.

If the concern isn't resolved, it can be escalated to the Clinical Director.

There are situations where everyone has genuinely tried to resolve the issue and the service still isn't a good fit. In that case, transitioning to another provider may be the most appropriate option.

Ending ABA services

Families can choose to end services.

We ask for 30 days' written notice so the clinical team has time to summarize progress, prepare discharge documentation and help with transition planning while the client is still receiving therapy.

Progressive Steps may also end services in some circumstances. Examples include serious ethical concerns, threatening or abusive behaviour toward team members, ongoing non-payment, or a continued mismatch between the family's expectations and the clinical recommendations despite attempts to resolve the issue.

Holiday closures

Progressive Steps closes on the statutory holidays observed by our organization.

Progressive Life Centre also closes between Christmas and New Year's. Sessions aren't scheduled during that annual closure.

A few additional policies for in-home ABA

Home-based therapy has some practical considerations that don't come up in a centre.

Before a session, the therapist may check in about sleep, food, medication, health or anything else that could affect the day.

We ask families to minimize avoidable interruptions such as loud television or music. Caregivers are welcome to observe and participate when that is helpful, but the therapist also needs enough space to build their own relationship with the client and run the session.

Therapists cannot be responsible for supervising siblings, although siblings may sometimes be included in an activity when appropriate.

The final part of the session may be used for data entry and clinical documentation. That isn't "downtime." The information being recorded is what allows us to monitor progress and make informed program changes.

Because therapists travel between homes, they may occasionally arrive a few minutes late. If someone expects to be more than five minutes late, they should contact the family. Missed time is made up when possible. If it can't be made up, families are only billed for the time the therapist was actually present.

Winter weather is another reality of providing home-based ABA in Ontario.

Therapists are not expected to drive when they feel conditions are unsafe. When appropriate, we may look at another therapist, a virtual session or a caregiver-training session instead.

Centre-based policies at Progressive Life Centre

For clients receiving services at Progressive Life Centre, there are a few additional procedures.

Participants need to be signed in and out unless they're authorized to do so independently. Only people authorized by the family can pick up a participant.

We don't have detailed clinical conversations in the waiting room because it is a shared space. Families who need to discuss progress or concerns can arrange a more private conversation with the clinical team.

Timely pickup is also important because staff may have another client or responsibility immediately afterward.

The centre may close during severe weather, unsafe road or walking conditions, power or heating failures, transportation shutdowns or significant staffing shortages caused by unsafe travel. Families are notified as early as possible and virtual services may be considered when appropriate.

During wet or winter weather, indoor non-slip shoes are required.

Medication is only administered with written authorization, in its original labelled packaging, and by staff who have been trained and authorized to do so. Clients also have the right to refuse medication.

Families should bring the personal supplies needed for each session and take them home afterward because storage at the centre is limited.

We also expect clients to treat the facility and equipment with care. Depending on the circumstances, families may be responsible for damage to property. Regular safety drills are conducted, and participants and caregivers are expected to follow emergency procedures when needed.

In-home services outside our usual geographic area

We have a defined geographic area for regular in-home ABA.

Families outside that area may still be able to receive services, but additional travel arrangements may apply because therapists are spending more time travelling between clients.

We discuss this before services begin so families know what to expect.

Working with other professionals

ABA is often only one part of a person's care.

With appropriate consent, we may collaborate with schools, occupational therapists, speech-language pathologists, psychologists or other professionals involved with the client.

In some situations, Progressive Steps also coordinates services or payments with an outside provider. When we are doing that additional care-coordination work, separate arrangements may apply.

Psychologist consultation can also be added when appropriate. The psychologist may review assessments, program data and other clinical information and make recommendations to the team. This is separate from the regular RBA-supervised ABA service and is discussed with families before it begins.

Why we put all of this in writing

Some families are surprised by how detailed our intake package is.

But most of these policies answer questions that come up eventually. What happens when someone gets sick? What if we go away for three weeks? What if my child doesn't like the therapist? Can I watch the session? Who sees my child's information? What happens when services end?

We would rather talk about those things before there is a problem.

Policies also shouldn't replace conversation. If something doesn't make sense, or your family's situation doesn't fit neatly into one of these examples, ask us. We want families to understand the service they're agreeing to and feel comfortable raising questions when they have them.

You can learn more about our approach to ABA and what families can expect from Progressive Steps in the other articles on our Resources page.